cfr_sections
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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 |
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| 20:20:2.0.1.1.9.1.381.1 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | A | Subpart A—Introduction, General Provisions and Definitions | § 416.101 Introduction. | SSA | [39 FR 28625, Aug. 9, 1974, as amended at 51 FR 11718, Apr. 7, 1986; 62 FR 38454, July 18, 1997; 83 FR 62459, Dec. 4, 2018] | The regulations in this part 416 (Regulations No. 16 of the Social Security Administration) relate to the provisions of title XVI of the Social Security Act as amended by section 301 of Pub. L. 92-603 enacted October 30, 1972, and as may thereafter be amended. Title XVI (Supplemental Security Income For The Aged, Blind, and Disabled) of the Social Security Act, as amended, established a national program, effective January 1, 1974, for the purpose of providing supplemental security income to individuals who have attained age 65 or are blind or disabled. The regulations in this part are divided into the following subparts according to subject content: (a) This subpart A contains this introduction, a statement of the general purpose underlying the supplemental security income program, general provisions applicable to the program and its administration, and definitions and use of terms occurring throughout this part. (b) Subpart B of this part covers in general the eligibility requirements which must be met for benefits under the supplemental security income program. It sets forth the requirements regarding residence, citizenship, age, disability, or blindness, and describes the conditions which bar eligibility and generally points up other conditions of eligibility taken up in greater detail elsewhere in the regulations (e.g., limitations on income and resources, receipt of support and maintenance, etc.). (c) Subpart C of this part sets forth the rules with respect to the filing of applications, requests for withdrawal of applications, cancellation of withdrawal requests and other similar requests. (d) Subpart D of this part sets forth the rules for computing the amount of benefits payable to an eligible individual and eligible spouse. (e) Subpart E of this part covers provisions with respect to periodic payment of benefits, joint payments, payment of emergency cash advances, payment of benefits prior to a determination of disability, prohibition against transfer or assignment of benefits, adjustment and waiver… | ||||
| 20:20:2.0.1.1.9.1.381.2 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | A | Subpart A—Introduction, General Provisions and Definitions | § 416.105 Administration. | SSA | [51 FR 11718, Apr. 7, 1986, as amended at 62 FR 38454, July 18, 1997] | The Supplemental Security Income for the Aged, Blind, and Disabled program is administered by the Social Security Administration. | ||||
| 20:20:2.0.1.1.9.1.381.3 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | A | Subpart A—Introduction, General Provisions and Definitions | § 416.110 Purpose of program. | SSA | [39 FR 28625, Aug. 9, 1974, as amended at 53 FR 12941, Apr. 20, 1988; 62 FR 38454, July 18, 1997] | The basic purpose underlying the supplemental security income program is to assure a minimum level of income for people who are age 65 or over, or who are blind or disabled and who do not have sufficient income and resources to maintain a standard of living at the established Federal minimum income level. The supplemental security income program replaces the financial assistance programs for the aged, blind, and disabled in the 50 States and the District of Columbia for which grants were made under the Social Security Act. Payments are financed from the general funds of the United States Treasury. Several basic principles underlie the program: (a) Objective tests. The law provides that payments are to be made to aged, blind, and disabled people who have income and resources below specified amounts. This provides objective measurable standards for determining each person's benefits. (b) Legal right to payments. A person's rights to supplemental security income payments—how much he gets and under what conditions—are clearly defined in the law. The area of administrative discretion is thus limited. If an applicant disagrees with the decision on his claim, he can obtain an administrative review of the decision and if still not satisfied, he may initiate court action. (c) Protection of personal dignity. Under the Federal program, payments are made under conditions that are as protective of people's dignity as possible. No restrictions, implied or otherwise, are placed on how recipients spend the Federal payments. (d) Nationwide uniformity of standards. The eligibility requirements and the Federal minimum income level are identical throughout the 50 States and the District of Columbia. This provides assurance of a minimum income base on which States may build supplementary payments. (e) Incentives to work and opportunities for rehabilitation. Payment amounts are not reduced dollar-for-dollar for work income but some of an applicant's income is counted toward the eligibility limit. Thus, recipients are en… | ||||
| 20:20:2.0.1.1.9.1.381.4 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | A | Subpart A—Introduction, General Provisions and Definitions | § 416.120 General definitions and use of terms. | SSA | [39 FR 28625, Aug. 9, 1974, as amended at 43 FR 25091, June 9, 1978; 51 FR 11719, Apr. 7, 1986; 60 FR 16374, Mar. 30, 1995; 62 FR 38454, July 18, 1997; 85 FR 73159, Nov. 16, 2020] | (a) Terms relating to acts and regulations. As used in this part: (1) The Act means the Social Security Act as amended (42 U.S.C. Chap. 7). (2) Wherever a title is referred to, it means such title of the Act. (3) Vocational Rehabilitation Act means the act approved June 2, 1920 (41 Stat. 735), 29 U.S.C. 31-42, as amended, and as may be amended from time to time hereafter. (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. As used in this part unless otherwise indicated: (1) Supplemental security income benefit means the amount to be paid to an eligible individual (or eligible individual and his eligible spouse) under title XVI of the Act. (2) Income means the receipt by an individual of any property or service which he can apply, either directly or by sale or conversion, to meeting his basic needs (see subpart K of this part). (3) Resources means cash or other liquid assets or any real or personal property that an individual owns and could convert to cash to be used for support and maintenance (see § 416.1201(a)). (4) Attainment of age. An individual attains a given age on the first moment of the day preceding the anniversary of his birth corresponding to such age. (5) Couple means an eligible individual and his eligible spouse. (6) Institution (see § 416.201). (7) Public institution (see § 416.201). (8) Resident of a public institution (see § 416.201). (9) State, unle… | ||||
| 20:20:2.0.1.1.9.1.381.5 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | A | Subpart A—Introduction, General Provisions and Definitions | § 416.121 Receipt of aid or assistance for December 1973 under an approved State plan under title I, X, XIV, or XVI of the Social Security Act. | SSA | [39 FR 32024, Sept. 4, 1974; 39 FR 33207, Sept. 16, 1974, as amended at 51 FR 11719, Apr. 7, 1986] | (a) Recipient of aid or assistance defined. As used in this part 416, the term individual who was a recipient of aid or assistance for December 1973 under a State plan approved under title I, X, XIV, or XVI of the Social Security Act means an individual who correctly received aid or assistance under such plan for December 1973 even though such aid or assistance may have been received subsequent to December 1973. It also includes an individual who filed an application prior to January 1974 and was otherwise eligible for aid or assistance for December 1973 under the provisions of such State plan but did not in fact receive such aid or assistance. It does not include an individual who received aid or assistance because of the provisions of 45 CFR 205.10(a) (pertaining to continuation of assistance until a fair hearing decision is rendered), as in effect in December 1973, and with respect to whom it is subsequently determined that such aid or assistance would not have been received without application of the provisions of such 45 CFR 205.10(a). (b) Aid or assistance defined. As used in this part 416, the term aid or assistance means aid or assistance as defined in titles I, X, XIV, and XVI of the Social Security Act, as in effect in December 1973, and such aid or assistance is eligible for Federal financial participation in accordance with those titles and the provisions of 45 CFR chapter II as in effect in December 1973. (c) Determinations of receipt of aid or assistance for December 1973. For the purpose of application of the provisions of this part 416, the determination as to whether an individual was a recipient of aid or assistance for December 1973 under a State plan approved under title I, X, XIV, or XVI of the Social Security Act will be made by the Social Security Administration. In making such determination, the Social Security Administration may take into consideration a prior determination by the appropriate State agency as to whether the individual was eligible for aid or assistance for Dece… | ||||
| 20:20:2.0.1.1.9.10.412.1 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1001 Purpose and scope. | SSA | [46 FR 29211, May 29, 1981, as amended at 62 FR 38454, July 18, 1997; 71 FR 16461, Mar. 31, 2006; 76 FR 24812, May 3, 2011] | This subpart describes the standards of performance and administrative requirements and procedures for States making determinations of disability for the Commissioner under title XVI of the Act. It also establishes the Commissioner's responsibilities in carrying out the disability determination function. (a) Sections 416.1001 through 416.1003 describe the purpose of the regulations and the meaning of terms frequently used in the regulations. They also briefly set forth the responsibilities of the Commissioner and the States covered in detail in other sections. (b) Sections 416.1010 through 416.1018 describe the Commissioner's and the State's responsibilities in performing the disability determination function. (c) Sections 416.1020 through 416.1033 describe the administrative responsibilities and requirements of the States. The corresponding role of the Commissioner is also set out. (d) Sections 416.1040 through 416.1050 describe the performance accuracy and processing time standards for measuring State agency performance. (e) Sections 416.1060 through 416.1061 describe when and what kind of assistance the Commissioner will provide State agencies to help them improve performance. (f) Sections 416.1070 through 416.1075 describe the level of performance below which the Commissioner will consider a State agency to be substantially failing to make disability determinations consistent with the regulations and other written guidelines and the resulting action the Commissioner will take. (g) Sections 416.1080 through 416.1083 describe the rules for resolving disputes concerning fiscal issues and providing hearings when we propose to find that a State is in substantial failure. (h) Sections 416.1090 through 416.1094 describe when and what action the Commissioner will take and what action the State will be expected to take if the Commissioner assumes the disability determination function from a State agency. | ||||
| 20:20:2.0.1.1.9.10.412.2 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1002 Definitions. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11021, Mar. 14, 1991; 62 FR 38454, July 18, 1997; 72 FR 51178, Sept. 6, 2007; 75 FR 62683, Oct. 13, 2010] | For purposes of this subpart: Act means the Social Security Act, as amended. Class or classes of cases means the categories into which disability claims are divided according to their characteristics. Commissioner means the Commissioner of Social Security or his or her authorized designee. Compassionate allowance means a determination or decision we make under a process that identifies for expedited handling claims that involve impairments that invariably qualify under the Listing of Impairments in appendix 1 to subpart P of part 404 of this chapter based on minimal, but sufficient, objective medical evidence. Determination of disability or disability determination means one or more of the following decisions: (a) Whether or not a person is under a disability; (b) The date a person's disability began; or (c) The date a person's disability ended. Disability means disability or blindness as defined in sections 1614(a) (2) and (3) of the Act. Disability determination function means making determinations as to disability or blindness and carrying out related administrative and other responsibilities. Disability program means the Federal program for providing supplemental security income benefits for the blind and disabled under title XVI of the Act, as amended. Initial means the first level of disability or blindness adjudication. Other written guidelines means written issuances such as Social Security Rulings and memoranda by the Commissioner of Social Security, the Deputy Commissioner for Programs and Policy, or the Associate Commissioner for Disability and the procedures, guides, and operating instructions in the Disability Insurance sections of the Program Operations Manual System that are instructive, interpretive, clarifying, and/or administrative and not designated as advisory or discretionary. The purpose of including the foregoing material in the definition is to assure uniform national application of program standards and service delivery to the public. Quick disability determi… | ||||
| 20:20:2.0.1.1.9.10.412.3 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1003 Basic responsibilities for us and the State. | SSA | [46 FR 29211, May 29, 1981, as amended at 72 FR 51178, Sept. 6, 2007] | (a) General. We will work with the State to provide and maintain an effective system for processing claims of those who apply for and who are receiving benefits under the disability program. We will provide program standards, leadership, and oversight. We do not intend to become involved in the State's ongoing management of the program except as is necessary and in accordance with these regulations. The State will comply with our regulations and other written guidelines. (b) Our responsibilities. We will: (1) Periodically review the regulations and other written guidelines to determine whether they insure effective and uniform administration of the disability program. To the extent feasible, we will consult with and take into consideration the experience of the States in issuing regulations and guidelines necessary to insure effective and uniform administration of the disability program; (2) Provide training materials or in some instances conduct or specify training (see § 416.1022); (3) Provide funds to the State agency for the necessary cost of performing the disability determination function (see § 416.1026); (4) Monitor and evaluate the performance of the State agency under the established standards (see §§ 416.1044 and 416.1045); and (5) Maintain liaison with the medical profession nationally and with national organizations and agencies whose interests or activities may affect the disability program. (c) Responsibilities of the State. The State will: (1) Provide management needed to insure that the State agency carries out the disability determination function so that disability determinations are made accurately and promptly; (2) Provide an organizational structure, adequate facilities, qualified personnel, medical consultant services, designated quick disability determination examiners (§§ 416.1019 and 416.1020(c)), and a quality assurance function (§§ 416.1020 through 416.1024); (3) Furnish reports and records relating to the administration of the disability program (§ 416.1025); (4) Subm… | ||||
| 20:20:2.0.1.1.9.10.413.10 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1017 Reasonable efforts to obtain review by a physician, psychiatrist, and psychologist. | SSA | [52 FR 23928, Sept. 9, 1987, as amended at 82 FR 5883, Jan. 18, 2017] | (a) When the evidence of record indicates the existence of a physical impairment, the State agency must make every reasonable effort to ensure that a medical consultant completes the medical portion of the case review and any applicable residual functional capacity assessment. When the evidence of record indicates the existence of a mental impairment, the State agency must make every reasonable effort to ensure that a psychological consultant completes the medical portion of the case review and any applicable residual functional capacity assessment. The State agency must determine if additional physicians, psychiatrists, and psychologists are needed to make the necessary reviews. When it does not have sufficient resources to make the necessary reviews, the State agency must attempt to obtain the resources needed. If the State agency is unable to obtain additional physicians, psychiatrists, and psychologists because of low salary rates or fee schedules, it should attempt to raise the State agency's levels of compensation to meet the prevailing rates for these services. If these efforts are unsuccessful, the State agency will seek assistance from us. We will assist the State agency as necessary. We will also monitor the State agency's efforts and where the State agency is unable to obtain the necessary services, we will make every reasonable effort to provide the services using Federal resources. (b) Federal resources may include the use of Federal contracts for the services of qualified psychiatrists and psychologists to review mental impairment cases. Where Federal resources are required to perform these reviews, which are a basic State agency responsibility, and where appropriate, the State agency's budget will be reduced accordingly. (c) Where every reasonable effort is made to obtain the services of a qualified psychiatrist or psychologist to review a mental impairment case, but the professional services are not obtained, a physician who is not a psychiatrist will review the mental impairment case. For these… | ||||
| 20:20:2.0.1.1.9.10.413.11 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1018 Notifying claimant of the disability determination. | SSA | [46 FR 29211, May 29, 1981, as amended at 75 FR 33169, June 11, 2010] | The State agency will prepare denial notices in accordance with subpart N of this part whenever it makes a disability determination which is fully or partially unfavorable to the claimant. | ||||
| 20:20:2.0.1.1.9.10.413.4 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1010 How a State notifies us that it wishes to perform the disability determination function. | SSA | (a) Deemed notice. Any State that has in effect as of June 1, 1981, an agreement with us to make disability determinations will be deemed to have given us notice that it wishes to perform the disability determination function, in lieu of continuing the agreement in effect after June 1, 1981. (b) Written notice. After June 1, 1981, a State not making disability determinations that wishes to perform the disability determination function under these regulations must notify us in writing. The notice must be from an official authorized to act for the State for this purpose. The State will provide an opinion from the State's Attorney General verifying the authority of the official who sent the notice to act for the State. | |||||
| 20:20:2.0.1.1.9.10.413.5 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1011 How we notify a State whether it may perform the disability determination function. | SSA | (a) If a State notifies us in writing that it wishes to perform the disability determination function, we will notify the State in writing whether or not it may perform the function. The State will begin performing the disability determination function beginning with the month we and the State agree upon. (b) If we have previously found that a State agency has substantially failed to make disability determinations in accordance with the law or these regulations and other written guidelines or if the State has previously notified us in writing that it does not wish to make disability determinations, the notice will advise the State whether the State agency may again make the disability determinations and, if so, the date and the conditions under which the State may again make them. | |||||
| 20:20:2.0.1.1.9.10.413.6 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1013 Disability determinations the State makes. | SSA | [46 FR 29211, May 29, 1981, as amended at 62 FR 38455, July 18, 1997] | (a) General rule. A State agency will make determinations of disability with respect to all persons in the State except those individuals whose cases are in a class specifically excluded by our written guidelines. A determination of disability made by the State is the determination of the Commissioner, except as described in § 416.903(d)(1). (b) New classes of cases. Where any new class or classes of cases arise requiring determinations of disability, we will determine the conditions under which a State may choose not to make the disability determinations. We will provide the State with the necessary funding to do the additional work. (c) Temporary transfer of classes of cases. We will make disability determinations for classes of cases temporarily transferred to us by the State agency if the State agency asks us to do so and we agree. The State agency will make written arrangements with us which will specify the period of time and the class or classes of cases we will do. | ||||
| 20:20:2.0.1.1.9.10.413.7 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1014 Responsibilities for obtaining evidence to make disability determinations. | SSA | [46 FR 29211, May 29, 1981, as amended at 79 FR 33683, June 12, 2014] | (a) We or the State agency will secure from the claimant or other sources any evidence the State agency needs to make a disability determination. When we secure the evidence, we will furnish it to the State agency for use in making the disability determination. (b) At our request, the State agency will obtain and furnish medical or other evidence and provide assistance as may be necessary for us to carry out our responsibility for making disability determinations in those classes of cases described in the written guidelines for which the State agency does not make the determination. | ||||
| 20:20:2.0.1.1.9.10.413.8 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1015 Making disability determinations. | SSA | [52 FR 23928, Sept. 9, 1987, as amended at 56 FR 11021, Mar. 14, 1991; 58 FR 47587, Sept. 9, 1993; 61 FR 11136, Mar. 19, 1996; 62 FR 38455, July 18, 1997; 65 FR 34959, June 1, 2000; 75 FR 62684, Oct. 13, 2010; 78 FR 66639, Nov. 6, 2013; 79 FR 51243, Aug. 28, 2014; 80 FR 63093, Oct. 19, 2015; 81 FR 73028, Oct. 24, 2016; 82 FR 5883, Jan. 18, 2017] | (a) When making a disability determination, the State agency will apply subpart I, part 416, of our regulations. (b) The State agency will make disability determinations based only on the medical and nonmedical evidence in its files. (c) Disability determinations will be made by: (1) A State agency medical or psychological consultant and a State agency disability examiner; (2) A State agency disability examiner alone when there is no medical evidence to be evaluated ( i.e. , no medical evidence exists or we are unable, despite making every reasonable effort, to obtain any medical evidence that may exist) and the individual fails or refuses, without a good reason, to attend a consultative examination (see § 416.918); (3) A State agency disability examiner alone if you are not a child (a person who has not attained age 18), and the claim is adjudicated under the quick disability determination process (see § 416.1019) or the compassionate allowance process (see § 416.1002), and the initial or reconsidered determination is fully favorable to you. This paragraph (c)(3) will no longer be effective on December 28, 2018 unless we terminate it earlier by publication of a final rule in the Federal Register ; or (4) A State agency disability hearing officer. See § 416.1016 for the definition of medical or psychological consultant and § 416.1415 for the definition of disability hearing officer. The State agency disability examiner and disability hearing officer must be qualified to interpret and evaluate medical reports and other evidence relating to the claimant's physical or mental impairments and as necessary to determine the capacities of the claimant to perform substantial gainful activity. See § 416.972 for what we mean by substantial gainful activity. See § 416.1016 for the definition of medical or psychological consultant and § 416.1415 for the definition of disability hearing officer. The State agency disability examiner and disability hearing officer must be qualified to interpret and evaluate medical repo… | ||||
| 20:20:2.0.1.1.9.10.413.9 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1016 Medical consultants and psychological consultants. | SSA | [82 FR 5883, Jan. 18, 2017] | (a) What is a medical consultant? A medical consultant is a member of a team that makes disability determinations in a State agency (see § 416.1015), or who is a member of a team that makes disability determinations for us when we make disability determinations ourselves. The medical consultant completes the medical portion of the case review and any applicable residual functional capacity assessment about all physical impairment(s) in a claim. (b) What qualifications must a medical consultant have? A medical consultant is a licensed physician, as defined in § 416.902(a)(1). (c) What is a psychological consultant? A psychological consultant is a member of a team that makes disability determinations in a State agency (see § 416.1015), or who is a member of a team that makes disability determinations for us when we make disability determinations ourselves. The psychological consultant completes the medical portion of the case review and any applicable residual functional capacity assessment about all mental impairment(s) in a claim. When we are unable to obtain the services of a qualified psychiatrist or psychologist despite making every reasonable effort (see § 416.1017) in a claim involving a mental impairment(s), a medical consultant will evaluate the mental impairment(s). (d) What qualifications must a psychological consultant have? A psychological consultant can be either a licensed psychiatrist or psychologist. We will only consider a psychologist qualified to be a psychological consultant if he or she: (1) Is licensed or certified as a psychologist at the independent practice level of psychology by the State in which he or she practices; and (2)(i) Possesses a doctorate degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the Council on Post-Secondary Accreditation; or (ii) Is listed in a national register of health service providers in psychology which the Commissioner of Social Security deems appropriate; and (3)… | ||||
| 20:20:2.0.1.1.9.10.414.12 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1019 Quick disability determination process. | SSA | [72 FR 51178, Sept. 6, 2007, as amended at 75 FR 62684, Oct. 13, 2010] | (a) If we identify a claim as one involving a high degree of probability that the individual is disabled, and we expect that the individual's allegations will be easily and quickly verified, we will refer the claim to the State agency for consideration under the quick disability determination process pursuant to this section and § 416.1020(c). (b) If we refer a claim to the State agency for a quick disability determination, a designated quick disability determination examiner must do all of the following: (1) Subject to the provisions in paragraph (c) of this section, make the disability determination after consulting with a State agency medical or psychological consultant if the State agency disability examiner determines consultation is appropriate or if consultation is required under § 416.926(c). The State agency may certify the disability determination forms to us without the signature of the medical or psychological consultant. (2) Make the quick disability determination based only on the medical and nonmedical evidence in the file. (3) Subject to the provisions in paragraph (c) of this section, make the quick disability determination by applying the rules in subpart I of this part. (c) If the quick disability determination examiner cannot make a determination that is fully favorable, or if there is an unresolved disagreement between the disability examiner and the medical or psychological consultant (except when a disability examiner makes the determination alone under § 416.1015(c)(3)), the State agency will adjudicate the claim using the regularly applicable procedures in this subpart. | ||||
| 20:20:2.0.1.1.9.10.415.13 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1020 General administrative requirements. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11021, Mar. 14, 1991; 56 FR 13365, Apr. 1, 1991; 72 FR 51178, Sept. 6, 2007] | (a) The State will provide the organizational structure, qualified personnel, medical consultant services, and a quality assurance function sufficient to ensure that disability determinations are made accurately and promptly. We may impose specific administrative requirements in these areas and in those under “Administrative Responsibilities and Requirements” in order to establish uniform, national administrative practices or to correct the areas of deficiencies which may later cause the State to be substantially failing to comply with our regulations or other written guidelines. We will notify the State, in writing, of the administrative requirements being imposed and of any administrative deficiencies it is required to correct. We will allow the State 90 days from the date of this notice to make appropriate corrections. Once corrected, we will monitor the State's administrative practices for 180 days. If the State does not meet the requirements or correct all of the deficiencies, or, if some of the deficiencies recur, we may initiate procedures to determine if the State is substantially failing to follow our regulations or other written guidelines. (b) The State is responsible for making accurate and prompt disability determinations. (c) Each State agency will designate experienced disability examiners to handle claims we refer to it under § 416.1019(a). | ||||
| 20:20:2.0.1.1.9.10.415.14 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1021 Personnel. | SSA | (a) Equal Employment Opportunity. The State will comply with all applicable Federal statutes, executive orders and regulations concerned with equal employment opportunities. (b) Selection, tenure, and compensation. The State agency will, except as may be inconsistent with paragraph (a) of this section, adhere to applicable State approved personnel standards in the selection, tenure, and compensation of any individual employed in the disability program. (c) Travel. The State will make personnel available to attend meetings or workshops as may be sponsored or approved by us for furthering the purposes of the disability program. (d) Restrictions. Subject to appropriate Federal funding, the State will, to the best of its ability, facilitate the processing of disability claims by avoiding personnel freezes, restrictions against overtime work, or curtailment of facilities or activities. | |||||
| 20:20:2.0.1.1.9.10.415.15 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1022 Training. | SSA | The State will insure that all employees have an acceptable level of competence. We will provide training and other instructional materials to facilitate basic and advanced technical proficiency of disability staff in order to insure uniformity and effectiveness in the administration of the disability program. We will conduct or specify training, as appropriate but only if: (a) A State agency's performance approaches unacceptable levels or (b) The material required for the training is complex or the capacity of the State to deliver the training is in doubt and uniformity of the training is essential. | |||||
| 20:20:2.0.1.1.9.10.415.16 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1023 Facilities. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11022, Mar. 14, 1991] | (a) Space, equipment, supplies, and other services. Subject to appropriate Federal funding, the State will provide adequate space, equipment, supplies, and other services to facilitate making accurate and prompt disability determinations. (b) Location of facilities. Subject to appropriate Federal funding, the State will determine the location where the disability determination function is to be performed so that disability determinations are made accurately and promptly. (c) Access. The State will permit us access to the premises where the disability determination function is performed and also where it is managed for the purposes of inspecting and obtaining information about the work and activities required by our regulations and assuring compliance with pertinent Federal statutes and regulations. Access includes personal onsite visits and other means, such as telecommunications, of contacting the State agency to obtain information about its functions. We will contact the State agency and give reasonable prior notice of the times and purposes of any visits. | ||||
| 20:20:2.0.1.1.9.10.415.17 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1024 Medical and other purchased services. | SSA | [46 FR 29211, May 29, 1981, as amended at 71 FR 16461, Mar. 31, 2006; 76 FR 24812, May 3, 2011] | The State will determine the rates of payment for purchasing medical or other services necessary to make determinations of disability. The rates may not exceed the highest rate paid by Federal or other agencies in the State for the same or similar type of service. The State will maintain documentation to support the rates of payment it uses. | ||||
| 20:20:2.0.1.1.9.10.415.18 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1025 Records and reports. | SSA | (a) The State will establish and maintain the records and furnish the schedules, financial, cost, and other reports relating to the administration of the disability programs as we may require. (b) The State will permit us and the Comptroller General of the United States (including duly authorized representatives) access to and the right to examine records relating to the work which the State performs under these regulations. These records will be retained by the State for the periods of time specified for retention of records in the Federal Procurement Regulations (41 CFR parts 1-20). | |||||
| 20:20:2.0.1.1.9.10.415.19 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1026 Fiscal. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11022, Mar. 14, 1991; 62 FR 38455, July 18, 1997] | (a) We will give the State funds, in advance or by way of reimbursement, for necessary costs in making disability determinations under these regulations. Necessary costs are direct as well as indirect costs as defined in 41 CFR part 1-15, subpart 1-15.7 of the Federal Procurement Regulations System for costs incurred before April 1, 1984; and 48 CFR part 31, subpart 31.6 of the Federal Acquisition Regulations System and Federal Management Circular A-74-4 1 as amended or superseded for costs incurred after March 31, 1984. 1 The circular is available from the Office of Administration, Publications Unit, Rm. G-236, New Executive Office Bldg., Washington, DC 20503. (b) The State will submit estimates of anticipated costs in the form of a budget at the time and in the manner we require. (c) We will notify the State of the amount which will be made available to it as well as what anticipated costs are being approved. (d) The State may not incur or make expenditures for items of cost not approved by us or in excess of the amount we make available to the State. (e) After the close of a period for which funds have been made available to the State, the State will submit a report of its expenditures. Based on an audit arranged by the State under Pub. L. 98-502, the Single Audit Act of 1984, or by the Inspector General of the Social Security Administration or based on an audit or review by the Social Security Administration (see § 416.1027), we will determine whether the expenditures were consistent with cost principles described in 41 CFR part 1-15, subpart 1-15.7 for costs incurred before April 1, 1984; and 48 CFR part 31, subpart 31.6 and Federal Management Circular A-74-4 for costs incurred after March 31, 1984; and in other applicable written guidelines in effect at the time the expenditures were made or incurred. (f) Any monies paid to the State which are used for purposes not within the scope of these regulations will be paid back to the Treasury of the United States. | ||||
| 20:20:2.0.1.1.9.10.415.20 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1027 Audits. | SSA | [56 FR 11022, Mar. 14, 1991, as amended at 62 FR 38455, July 18, 1997] | (a) Audits performed by the State —(1) Generally. Audits of account and records pertaining to the administration of the disability program under the Act, will be performed by the States in accordance with the Single Audit Act of 1984 (Pub. L. 98-502) which establishes audit requirements for States receiving Federal assistance. If the audit performed by the State meets our program requirements, we will accept the findings and recommendations of the audit. The State will make every effort to act upon and resolve any items questioned in the audit. (2) Questioned items. Items questioned as a result of an audit under the Single Audit Act of 1984 of a cross-cutting nature will be resolved by the Department of Health and Human Services, Office of Grant and Contract Financial Management. A cross-cutting issue is one that involves more than one Federal awarding agency. Questioned items affecting only the disability program will be resolved by SSA in accord with paragraph (b)(2) of this section. (3) State appeal of audit determinations. The Office of Grant and Contract Financial Management will notify the State of its determination on questioned cross-cutting items. If the State disagrees with that determination, it may appeal in writing within 60 days of receiving the determination. State appeals of a cross-cutting issue as a result of an audit under the Single Audit Act of 1984 will be made to the Department of Health and Human Services' Departmental Appeals Board. The rules for hearings and appeals are provided in 45 CFR part 16. (b) Audits performed by the Commissioner —(1) Generally. If the State does not perform an audit under the Single Audit Act of 1984 or the audit performed is not satisfactory for disability program purposes, the books of account and records in the State pertaining to the administration of the disability programs under the Act will be audited by the SSA's Inspector General or audited or reviewed by SSA as appropriate. These audits or reviews will be conducted to determine whether the… | ||||
| 20:20:2.0.1.1.9.10.415.21 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1028 Property. | SSA | The State will have title to equipment purchased for disability program purposes. The State will be responsible for maintaining all property it acquires or which we furnish to it for performing the disability determination function. The State will identify the equipment by labeling and by inventory and will credit the SSA account with the fair market value of disposed property. In the event we assume the disability determination function from a State, ownership of all property and equipment acquired with SSA funds will be transferred to us effective on the date the State is notified that we are assuming the disability determination function or we are notified that the State is terminating the relationship. | |||||
| 20:20:2.0.1.1.9.10.415.22 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1029 Participation in research and demonstration projects. | SSA | We will invite State participation in federally funded research and demonstration projects to assess the effectiveness of the disability program and to ascertain the effect of program policy changes. Where we determine that State participation is necessary for the project to be complete, for example, to provide national uniformity in a claims process, State participation is mandatory. | |||||
| 20:20:2.0.1.1.9.10.415.23 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1030 Coordination with other agencies. | SSA | (a) The State will establish cooperative working relationships with other agencies concerned with serving the disabled and, insofar as practicable, use their services, facilities, and records to: (1) Assist the State in developing evidence and making determinations of disability; and (2) Insure that referral of disabled or blind persons for rehabilitation services will be carried out effectively. (b) The State may pay these agencies for the services, facilities, or records they provide. The State will include these costs in its estimates of anticipated costs and reports of actual expenditures. | |||||
| 20:20:2.0.1.1.9.10.415.24 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1031 Confidentiality of information and records. | SSA | The State will comply with the confidentiality of information, including the security of systems, and records requirements described in 20 CFR part 401 and pertinent written guidelines (see § 416.1033). | |||||
| 20:20:2.0.1.1.9.10.415.25 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1032 Other Federal laws and regulations. | SSA | The State will comply with the provisions of other Federal laws and regulations that directly affect its responsibilities in carrying out the disability determination function; for example, Treasury Department regulations on letters of credit (31 CFR part 205). | |||||
| 20:20:2.0.1.1.9.10.415.26 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1033 Policies and operating instructions. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991] | (a) We will provide the State agency with written guidelines necessary for it to carry out its responsibilities in performing the disability determination function. (b) The State agency making determinations of disability will comply with our written guidelines that are not designated as advisory or discretionary. (See § 416.1002 for what we mean by written guidelines.) (c) A representative group of State agencies will be given an opportunity to participate in formulating disability program policies that have an effect on their role in carrying out the disability determination function. State agencies will also be given an opportunity to comment before changes are made in written guidelines unless delay in issuing a change may impair service to the public. | ||||
| 20:20:2.0.1.1.9.10.416.27 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1040 General. | SSA | [56 FR 11023, Mar. 14, 1991] | The following sections provide the procedures and guidelines we use to determine whether the State agency is substantially complying with our regulations and other written guidelines, including meeting established national performance standards. We use performance standards to help assure effective and uniform administration of our disability program and to measure whether the performance of the disability determination function by each State agency is acceptable. Also, the standards are designed to improve overall State agency performance in the disability determination process and to ensure that benefits are made available to all eligible persons in an accurate and efficient manner. We measure the performance of a State agency in two areas—processing time and quality of documentation and decisions on claims. State agency compliance is also judged by State agency adherence to other program requirements. | ||||
| 20:20:2.0.1.1.9.10.416.28 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1041 Standards of performance. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991; 62 FR 38455, July 18, 1997] | (a) General. The performance standards include both a target level of performance and a threshold level of performance for the State agency. The target level represents a level of performance that we and the States will work to attain in the future. The threshold level is the minimum acceptable level of performance. Performance below the threshold level will be the basis for the Commissioner's taking from the State agency partial or complete responsibility for performing the disability determination function. Intermediate State agency goals are designed to help each State agency move from its current performance levels to the target levels. (b) The target level. The target level is the optimum level of performance. There are three targets—one for combined title II and title XVI initial performance accuracy, one for title II initial processing time, and one for title XVI initial processing time. (c) The threshold level. The threshold level is the minimum acceptable level of performance. There are three thresholds—one for combined title II and title XVI initial performance accuracy, one for title II initial processing time, and one for title XVI initial processing time. (d) Intermediate goals. Intermediate goals are levels of performance between the threshold levels and the target levels established by our appropriate Regional Commissioner after negotiation with each State agency. The intermediate goals are designed to help the State agencies reach the target levels. Failure to meet these goals is not a cause for considering the State agency to be substantially failing to comply with the performance standards. However, failure to meet the intermediate goals may result in consultation and an offer of optional performance support depending on the availability of our resources. | ||||
| 20:20:2.0.1.1.9.10.416.29 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1042 Processing time standards. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991] | (a) General. Title II processing time refers to the average number of days (including Saturdays, Sundays, and holidays) it takes a State agency to process an initial disability claim from the day the case folder is received in the State agency until the day it is released to us by the State agency. Title XVI processing time refers to the average number of days, including Saturdays, Sundays, and holidays, from the day of receipt of the initial disability claim in the State agency until systems input of a presumptive disability decision or the day the case folder is released to us by the State agency, whichever is earlier. (b) Target levels. The processing time target levels are: (1) 37 days for title II initial claims. (2) 43 days for title XVI initial claims. (c) Threshold levels. The processing time threshold levels are: (1) 49.5 days for title II initial claims. (2) 57.9 days for title XVI initial claims. | ||||
| 20:20:2.0.1.1.9.10.416.30 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1043 Performance accuracy standard. | SSA | (a) General. Performance accuracy refers to the percentage of cases that do not have to be returned to State agencies for further development or correction of decisions based on evidence in the files and as such represents the reliability of State agency adjudication. The definition of performance accuracy includes the measurement of factors that have a potential for affecting a decision, as well as the correctness of the decision. For example, if a particular item of medical evidence should have been in the file but was not included, even though its inclusion does not change the result in the case, that is a performance error. Performance accuracy, therefore, is a higher standard than decisional accuracy. As a result, the percentage of correct decisions is significantly higher than what is reflected in the error rate established by SSA's quality assurance system. (b) Target level. The State agency initial performance accuracy target level for combined title II and title XVI cases is 97 percent with a corresponding decision accuracy rate of 99 percent. (c) Intermediate goals. These goals will be established annually by SSA's regional commissioner after negotiation with the State and should be used as stepping stones to progress towards our targeted level of performance. (d) Threshold levels. The State agency initial performance accuracy threshold level for combined title II and title XVI cases is 90.6 percent. | |||||
| 20:20:2.0.1.1.9.10.416.31 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1044 How and when we determine whether the processing time standards are met. | SSA | [46 FR 29211, May 29, 1981, as amended at 56 FR 11023, Mar. 14, 1991] | (a) How we determine processing times. For all initial title II cases, we calculate the mean number of days, including Saturdays, Sundays, and holidays, from the day the case folder is received in the State agency until the day it is released to us by the State agency. For initial title XVI cases, we calculate the mean number of days, including Saturdays, Sundays, and holidays, from the day the case folder is received in the State agency until the day there is systems input of a presumptive disability decision or the day the case folder is released to us by the State agency, whichever is earlier. (b) Frequency of review. Title II processing times and title XVI processing times are monitored separately on a quarterly basis. The determination as to whether or not the processing time thresholds have been met is made at the end of each quarter each year. Quarterly State-by-State mean processing times are compared with the threshold levels for both title II and title XVI. | ||||
| 20:20:2.0.1.1.9.10.416.32 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1045 How and when we determine whether the performance accuracy standard is met. | SSA | (a) How we determine performance accuracy. We determine a State agency's performance accuracy rate on the basis of decision and documentation errors identified in our review of the sample cases. (b) Frequency of review. Title II and title XVI initial performance accuracy are monitored together on a quarterly basis. The determinations as to whether the performance accuracy threshold has been met is made at the end of each quarter each year. Quarterly State-by-State combined initial performance accuracy rates are compared to the established threshold level. | |||||
| 20:20:2.0.1.1.9.10.416.33 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1050 Action we will take if a State agency does not meet the standards. | SSA | [56 FR 11023, Mar. 14, 1991] | If a State agency does not meet two of the three established threshold levels (one of which must be performance accuracy) for two or more consecutive calendar quarters, we will notify the State agency in writing that it is not meeting the standards. Following our notification, we will provide the State agency appropriate performance support described in §§ 416.1060, 416.1061 and 416.1062 for a period of up to 12 months. | ||||
| 20:20:2.0.1.1.9.10.417.34 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1060 How we will monitor. | SSA | [56 FR 11023, Mar. 14, 1991] | We will regularly analyze State agency combined title II and title XVI initial performance accuracy rate, title II initial processing time, and title XVI initial processing time. Within budgeted resources, we will also routinely conduct fiscal and administrative management reviews and special onsite reviews. A fiscal and administrative management review is a fact-finding mission to review particular aspects of State agency operations. During these reviews we will also review the quality assurance function. This regular monitoring and review program will allow us to determine the progress each State is making and the type and extent of performance support we will provide to help the State progress toward threshold, intermediate, and/or target levels. | ||||
| 20:20:2.0.1.1.9.10.417.35 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1061 When we will provide performance support. | SSA | [56 FR 11023, Mar. 14, 1991] | (a) Optional support. We may offer, or a State may request, performance support at any time that the regular monitoring and review process reveals that support could enhance performance. The State does not have to be below the initial performance accuracy rate of 90.6 percent to receive performance support. Support will be offered, or granted upon request, based on available resources. (b) Mandatory support. (1) We will provide a State agency with performance support if regular monitoring and review reveal that two of three threshold levels (one of which must be performance accuracy) are not met for two consecutive calendar quarters. (2) We may also decide to provide a State agency with mandatory performance support if regular monitoring and review reveal that any one of the three threshold levels is not met for two consecutive calendar quarters. Support will be provided based on available resources. (3) The threshold levels are: (i) Combined title II and title XVI initial performance accuracy rate—90.6 percent, (ii) Title II initial processing time—49.5 days, and (iii) Title XVI initial processing time—57.9 days. | ||||
| 20:20:2.0.1.1.9.10.417.36 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1062 What support we will provide. | SSA | [56 FR 11024, Mar. 14, 1991] | Performance support may include, but is not limited to, any or all of the following: (a) An onsite review of cases processed by the State agency emphasizing adherence to written guidelines. (b) A request that necessary administrative measures be implemented (e.g., filling staffing vacancies, using overtime, assisting with training activities, etc.). (c) Provisions for Federal personnel to perform onsite reviews, conduct training, or perform other functions needed to improve performance. (d) Provisions for fiscal aid to allow for overtime, temporary hiring of additional staff, etc., above the authorized budget. | ||||
| 20:20:2.0.1.1.9.10.418.37 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1070 General. | SSA | [56 FR 11024, Mar. 14, 1991] | After a State agency falls below two of three established threshold levels, one being performance accuracy, for two consecutive quarters, and after the mandatory performance support period, we will give the State agency a 3-month adjustment period. During this 3-month period we will not require the State agency to meet the threshold levels. Following the adjustment period, if the State agency again falls below two of three threshold levels, one being performance accuracy, in two consecutive quarters during the next 12 months, we will notify the State that we propose to find that the State agency has substantially failed to comply with our standards and advise it that it may request a hearing on that issue. After giving the State notice and an opportunity for a hearing, if it is found that a State agency has substantially failed to make disability determinations consistent with the Act, our regulations, or other written guidelines, we will assume partial or complete responsibility for performing the disability determination function after we have complied with §§ 416.1090 and 416.1092. | ||||
| 20:20:2.0.1.1.9.10.418.38 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1071 Good cause for not following the Act, our regulations, or other written guidelines. | SSA | [56 FR 11024, Mar. 14, 1991] | If a State has good cause for not following the Act, our regulations, or other written guidelines, we will not find that the State agency has substantially failed to meet our standards. We will determine if good cause exists. Some of the factors relevant to good cause are: (a) Disasters such as fire, flood, or civil disorder, that— (1) Require the diversion of significant personnel normally assigned to the disability determination function, or (2) Destroyed or delayed access to significant records needed to make accurate disability determinations; (b) Strikes of State agency staff or other government or private personnel necessary to the performance of the disability determination function; (c) Sudden and unanticipated workload changes which result from changes in Federal law, regulations, or written guidelines, systems modification or systems malfunctions, or rapid, unpredictable caseload growth for a 6-month period or longer. | ||||
| 20:20:2.0.1.1.9.10.418.39 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1075 Finding of substantial failure. | SSA | A finding of substantial failure with respect to a State may not be made unless and until the State is afforded an opportunity for a hearing. | |||||
| 20:20:2.0.1.1.9.10.419.40 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1080 Notice of right to hearing on proposed finding of substantial failure. | SSA | [56 FR 11024, Mar. 14, 1991] | If, following the mandatory performance support period and the 3-month adjustment period, a State agency again falls below two of three threshold levels (one being performance accuracy) in two consecutive quarters in the succeeding 12 months, we will notify the State in writing that we will find that the State agency has substantially failed to meet our standards unless the State submits a written request for a hearing with the Department of Health and Human Services' Departmental Appeals Board within 30 days after receiving the notice. The notice will identify the threshold levels that were not met by the State agency, the period during which the thresholds were not met, and the accuracy and processing time levels attained by the State agency during this period. If a hearing is not requested, the State agency will be found to have substantially failed to meet our standards, and we will implement our plans to assume the disability determination function. | ||||
| 20:20:2.0.1.1.9.10.419.41 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1081 Disputes on matters other than substantial failure. | SSA | [56 FR 11024, Mar. 14, 1991] | Disputes concerning monetary disallowances will be resolved in proceedings before the Department of Health and Human Services, Departmental Appeals Board if the issue cannot be resolved between us and the State. Disputes other than monetary disallowances will be resolved through an appeal to the Commissioner of Social Security, who will make the final decision. (See § 416.1027.) | ||||
| 20:20:2.0.1.1.9.10.419.42 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1082 Who conducts the hearings. | SSA | [46 FR 29211, May 29, 1981, as amended at 62 FR 38455, July 18, 1997] | If a hearing is required, it will be conducted by the Department of Health and Human Services' Departmental Appeals Board (the Board). | ||||
| 20:20:2.0.1.1.9.10.419.43 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1083 Hearings and appeals process. | SSA | The rules for hearings and appeals before the Board are provided in 45 CFR part 16. A notice under § 416.1080 of this subpart will be considered a “final written decision” for purposes of Board review. | |||||
| 20:20:2.0.1.1.9.10.420.44 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1090 Assumption when we make a finding of substantial failure. | SSA | (a) Notice to State. When we find that substantial failure exists, we will notify the State in writing that we will assume responsibility for performing the disability determination function from the State agency, whether the assumption will be partial or complete, and the date on which the assumption will be effective. (b) Effective date of assumption. The date of any partial or complete assumption of the disability determination function from a State agency may not be earlier than 180 days after our finding of substantial failure, and not before compliance with the requirements of § 416.1092. | |||||
| 20:20:2.0.1.1.9.10.420.45 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1091 Assumption when State no longer wishes to perform the disability determination function. | SSA | [46 FR 29211, May 29, 1981, as amended at 62 FR 38455, July 18, 1997] | (a) Notice to the Commissioner. If a State no longer wishes to perform the disability determination function, it will notify us in writing. The notice must be from an official authorized to act for the State for this purpose. The State will provide an opinion from the State's Attorney General verifying the authority of the official who gave the notice. (b) Effective date of assumption. The State agency will continue to perform whatever activities of the disability determination function it is performing at the time the notice referred to in paragraph (a) of this section is given for not less than 180 days or, if later, until we have complied with the requirements of § 416.1092. For example, if the State is not making disability determinations (because we previously assumed responsibility for making them) but is performing other activities related to the disability determination function at the time it gives notice, the State will continue to do these activities until the requirements of this paragraph are met. Thereafter, we will assume complete responsibility for performing the disability determination function. | ||||
| 20:20:2.0.1.1.9.10.420.46 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1092 Protection of State employees. | SSA | (a) Hiring preference. We will develop and initiate procedures to implement a plan to partially or completely assume the disability determination function from the State agency under § 416.1090 or § 416.1091, as appropriate. Except for the State agency's administrator, deputy administrator, or assistant administrator (or his equivalent), we will give employees of the State agency who are capable of performing duties in the disability determination function preference over any other persons in filling positions with us for which they are qualified. We may also give a preference in hiring to the State agency's administrator, deputy administrator, or assistant administrator (or his equivalent). We will establish a system for determining the hiring priority among the affected State agency employees in those instances where we are not hiring all of them. (b) Determination by Secretary of Labor. We will not assume responsibility for performing the disability determination function from a State until the Secretary of Labor determines that the State has made fair and equitable arrangements under applicable Federal, State and local law to protect the interests of employees who will be displaced from their employment because of the assumption and who we will not hire. | |||||
| 20:20:2.0.1.1.9.10.420.47 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1093 Limitation on State expenditures after notice. | SSA | The State agency may not, after it receives the notice referred to in § 416.1090, or gives the notice referred to in § 416.1091, make any new commitments to spend funds allocated to it for performing the disability determination function without the approval of the appropriate SSA regional commissioner. The State will make every effort to close out as soon as possible all existing commitments that relate to performing the disability determination function. | |||||
| 20:20:2.0.1.1.9.10.420.48 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | J | Subpart J—Determinations of Disability | § 416.1094 Final accounting by the State. | SSA | The State will submit its final claims to us as soon as possible, but in no event later than 1 year from the effective date of our assumption of the disability determination function unless we grant an extension of time. When the final claim(s) is submitted, a final accounting will be made by the State of any funds paid to the State under § 416.1026 which have not been spent or committed prior to the effective date of our assumption of the disability determination function. Disputes concerning final accounting issues which cannot be resolved between the State and us will be resolved in proceedings before the Grant Appeals Board as described in 45 CFR part 416. | |||||
| 20:20:2.0.1.1.9.11.421.1 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1100 Income and SSI eligibility. | SSA | [50 FR 48573, Nov. 26, 1985] | You are eligible for supplemental security income (SSI) benefits if you are an aged, blind, or disabled person who meets the requirements described in subpart B and who has limited income and resources. Thus, the amount of income you have is a major factor in deciding whether you are eligible for SSI benefits and the amount of your benefit. We count income on a monthly basis. Generally, the more income you have the less your benefit will be. If you have too much income, you are not eligible for a benefit. However, we do not count all of your income to determine your eligibility and benefit amount. We explain in the following sections how we treat your income for the SSI program. These rules apply to the Federal benefit and to any optional State supplement paid by us on behalf of a State (§ 416.2025) except as noted in subpart T and in the Federal-State agreements with individual States. While this subpart explains how we count income, subpart D of these regulations explains how we determine your benefits, including the provision that we generally use countable income in a prior month to determine how much your benefit amount will be for a month in which you are eligible (§ 416.420). | ||||
| 20:20:2.0.1.1.9.11.421.2 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1101 Definition of terms. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48573, Nov. 26, 1985; 51 FR 10616, Mar. 28, 1986; 60 FR 16375, Mar. 30, 1995] | As used in this subpart— Calendar quarter means a period of three full calendar months beginning with January, April, July, or October. Child means someone who is not married, is not the head of a household, and is either under age 18 or is under age 22 and a student. (See § 416.1856) Couple means an eligible individual and his or her eligible spouse. Current market value means the price of an item on the open market in your locality. Federal benefit rate means the monthly payment rate for an eligible individual or couple. It is the figure from which we subtract countable income to find out how much your Federal SSI benefit should be. The Federal benefit rate does not include the rate for any State supplement paid by us on behalf of a State. Institution means an establishment which makes available some treatment or services beyond food and shelter to four or more persons who are not related to the proprietor. (See § 416.201) Spouse means someone who lives with another person as that person's husband or wife. (See § 416.1806) We, Us, or Our means the Social Security Administration. You or Your means a person who is applying for, or already receiving, SSI benefits. | ||||
| 20:20:2.0.1.1.9.11.421.3 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1102 What is income? | SSA | [89 FR 21209, Mar. 27, 2024] | Income is anything that you receive in cash or in-kind that you can use to meet your needs for food or shelter. For purposes of this definition, income may be received actually or constructively. Income is received constructively, unless there are significant restrictions on your ability to receive it, if it is under your control or you can use it despite not actually receiving it. Sometimes income also includes more or less than you actually receive (see §§ 416.1110 and 416.1123(b)). In-kind income is not cash but is something else that you can use to meet your needs for food or shelter. Exception: Food is not included in the calculations of in-kind support and maintenance, which is a type of unearned income that we have special rules for valuing (see §§ 416.1130 through 416.1148). | ||||
| 20:20:2.0.1.1.9.11.421.4 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1103 What is not income? | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 49 FR 48038, Dec. 10, 1984; 57 FR 53850, Nov. 13, 1992; 59 FR 33907, July 1, 1994; 70 FR 6344, Feb. 7, 2005; 89 FR 21209, Mar. 27, 2024] | Some things you receive are not income because you cannot use them as food or shelter, or use them to obtain food or shelter. In addition, what you receive from the sale or exchange of your own property is not income; it remains a resource. The following are some items that are not income: (a) Medical care and services. Medical care and services are not income if they are any of the following: (1) Given to you free of charge or paid for directly to the provider by someone else; (2) Room and board you receive during a medical confinement; (3) Assistance provided in cash or in kind (including food or shelter) under a Federal, State, or local government program whose purpose is to provide medical care or medical services (including vocational rehabilitation); (4) In-kind assistance (except shelter) provided under a nongovernmental program whose purpose is to provide medical care or medical services; (5) Cash provided by any nongovernmental medical care or medical services program or under a health insurance policy (except cash to cover food or shelter) if the cash is either: (i) Repayment for program-approved services you have already paid for; or (ii) A payment restricted to the future purchase of a program-approved service. (6) Direct payment of your medical insurance premiums by anyone on your behalf. (7) Payments from the Department of Veterans Affairs resulting from unusual medical expenses. (b) Social services. Social services are not income if they are any of the following: (1) Assistance provided in cash or in kind (but not received in return for a service you perform) under any Federal, State, or local government program whose purpose is to provide social services including vocational rehabilitation (Example: Cash given you by the Department of Veterans Affairs to purchase aid and attendance); (2) In-kind assistance (except shelter) provided under a nongovernmental program whose purpose is to provide social services; or (3) Cash provided by a nongovernmental social services program (except… | ||||
| 20:20:2.0.1.1.9.11.421.5 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1104 Income we count. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 65 FR 16815, Mar. 30, 2000; 70 FR 6345, Feb. 7, 2005; 89 FR 21209, Mar. 27, 2024] | We have described generally what income is and is not for SSI purposes (§ 416.1103). There are different types of income, earned and unearned, and we have rules for counting each. The earned income rules are described in §§ 416.1110 through 416.1112 and the unearned income rules are described in §§ 416.1120 through 416.1124. One type of unearned income is in-kind support and maintenance (shelter), which we value depending on your living arrangement. These rules are described in §§ 416.1130 through 416.1148 of this part. In some situations we must consider the income of certain people with whom you live as available to you and part of your income. These rules are described in §§ 416.1160 through 416.1169. We use all of these rules to determine the amount of your countable income—the amount that is left after we subtract what is not income or is not counted. | ||||
| 20:20:2.0.1.1.9.11.422.6 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1110 What is earned income. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 48 FR 23179, May 24, 1983; 50 FR 48574, Nov. 26, 1985; 56 FR 3212, Jan. 29, 1991; 59 FR 43471, Aug. 24, 1994; 75 FR 1273, Jan. 11, 2010; 75 FR 54287, Sept. 7, 2010] | Earned income may be in cash or in kind. We may include more of your earned income than you actually receive. We include more than you actually receive if amounts are withheld from earned income because of a garnishment or to pay a debt or other legal obligation, or to make any other payments. Earned income consists of the following types of payments: (a) Wages —(1) Wages paid in cash—general. Wages are what you receive (before any deductions) for working as someone else's employee. Wages are the same for SSI purposes as for the social security retirement program's earnings test. ( See § 404.429(c) of this chapter.) Wages include salaries, commissions, bonuses, severance pay, and any other special payments received because of your employment. (2) Wages paid in cash to uniformed service members. Wages paid in cash to uniformed service members include basic pay, some types of special pay, and some types of allowances. Allowances for on-base housing or privatized military housing are unearned income in the form of in-kind support and maintenance. Cash allowances paid to uniformed service members for private housing are wages. (3) Wages paid in kind. Wages may also include the value of food, clothing, shelter, or other items provided instead of cash. We refer to this type of income as in-kind earned income. However, if you are a domestic or agricultural worker, the law requires us to treat your in-kind pay as unearned income. (b) Net earnings from self-employment. Net earnings from self-employment are your gross income from any trade or business that you operate, less allowable deductions for that trade or business. Net earnings also include your share of profit or loss in any partnership to which you belong. For taxable years beginning before January 1, 2001, net earnings from self-employment under the SSI program are the same net earnings that we would count under the social security retirement insurance program and that you would report on your Federal income tax return. (See § 404.1080 of this chapt… | ||||
| 20:20:2.0.1.1.9.11.422.7 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1111 How we count earned income. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 48 FR 23179, May 24, 1983; 48 FR 30357, July 1, 1983; 50 FR 48574, Nov. 26, 1985; 58 FR 63889, Dec. 3, 1993; 59 FR 43471, Aug. 24, 1994; 71 FR 45378, Aug. 9, 2006] | (a) Wages. We count wages at the earliest of the following points: when you receive them or when they are credited to your account or set aside for your use. We determine wages for each month. We count wages for services performed as a member of a uniformed service (as defined in § 404.1330 of this chapter) as received in the month in which they are earned. (b) Net earnings from self-employment. We count net earnings from self-employment on a taxable year basis. However, we divide the total of these earnings equally among the months in the taxable year to get your earnings for each month. For example, if your net earnings for a taxable year are $2,400, we consider that you received $200 in each month. If you have net losses from self-employment, we divide them over the taxable year in the same way, and we deduct them only from your other earned income. (c) Payments for services in a sheltered workshop or activities center. We count payments you receive for services performed in a sheltered workshop or work activities center when you receive them or when they are set aside for your use. We determine the amount of the payments for each calendar quarter. (d) In-kind earned income. We use the current market value of in-kind earned income for SSI purposes. (See § 416.1101 for a definition of current market value.) If you receive an item that is not fully paid for and are responsible for the unpaid balance, only the paid-up value is income to you. (See the example in § 416.1123(c)). (e) Royalties and honoraria. We count payments of royalties to you in connection with any publication of your work, and honoraria, to the extent received for services rendered, at the earliest of the following points: when you receive them, when they are credited to your account, or when they are set aside for your use. (See § 416.1111(b) if you receive royalties as part of your trade or business.) | ||||
| 20:20:2.0.1.1.9.11.422.8 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1112 Earned income we do not count. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 48 FR 21943, May 16, 1983; 50 FR 48574, Nov. 26, 1985; 58 FR 63889, Dec. 3, 1993; 59 FR 41405, Aug. 12, 1994; 65 FR 82912, Dec. 29, 2000; 71 FR 45378, Aug. 9, 2006; 71 FR 66866, Nov. 17, 2006; 75 FR 54287, Sept. 7, 2010] | (a) General. While we must know the source and amount of all of your earned income for SSI, we do not count all of it to determine your eligibility and benefit amount. We first exclude income as authorized by other Federal laws (see paragraph (b) of this section). Then we apply the other exclusions in the order listed in paragraph (c) of this section to the rest of your income in the month. We never reduce your earned income below zero or apply any unused earned income exclusion to unearned income. (b) Other Federal laws. Some Federal laws other than the Social Security Act provide that we cannot count some of your earned income for SSI purposes. We list the laws and exclusions in the appendix to this subpart which we update periodically. (c) Other earned income we do not count. We do not count as earned income— (1) Any refund of Federal income taxes you receive under section 32 of the Internal Revenue Code (relating to earned income tax credit) and any payment you receive from an employer under section 3507 of the Internal Revenue Code (relating to advance payment of earned income tax credit); (2) The first $30 of earned income received in a calendar quarter if you receive it infrequently or irregularly. We consider income to be received infrequently if you receive it only once during a calendar quarter from a single source and you did not receive it in the month immediately preceding that month or in the month immediately subsequent to that month. We consider income to be received irregularly if you cannot reasonably expect to receive it. (3) If you are under age 22 and a student who is regularly attending school as described in § 416.1861: (i) For earned income beginning January 1, 2002, monthly and yearly maximum amounts that are the larger of: (A) The monthly and yearly amounts for the previous year, or (B) Monthly and yearly maximum amounts increased for changes in the cost-of-living, calculated in the same manner as the Federal benefit rates described in § 416.405, except that we will use t… | ||||
| 20:20:2.0.1.1.9.11.423.10 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1121 Types of unearned income. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 56 FR 36000, July 30, 1991; 59 FR 43471, Aug. 24, 1994; 70 FR 6345, Feb. 7, 2005; 89 FR 21209, Mar. 27, 2024] | Some types of unearned income are— (a) Annuities, pensions, and other periodic payments. This unearned income is usually related to prior work or service. It includes, for example, private pensions, social security benefits, disability benefits, veterans benefits, worker's compensation, railroad retirement annuities and unemployment insurance benefits. (b) Alimony and support payments. For SSI purposes, alimony and support payments are cash or in-kind contributions to meet some or all of a person's needs for food or shelter. Support payments may be made voluntarily or because of a court order. Alimony (sometimes called maintenance ) is an allowance made by a court from the funds of one spouse to the other spouse in connection with a suit for separation or divorce. (c) Dividends, interest, and certain royalties. Dividends and interest are returns on capital investments, such as stocks, bonds, or savings accounts. Royalties are compensation paid to the owner for the use of property, usually copyrighted material or natural resources such as mines, oil wells, or timber tracts. Royalty compensation may be expressed as a percentage of receipts from using the property or as an amount per unit produced. (See § 416.1110(b) if you receive royalties as part of your trade or business and § 416.1110(e) if you receive royalties in connection with the publication of your work.) (d) Rents. Rents are payments you receive for the use of real or personal property such as land, housing, or machinery. We deduct from rental payments your ordinary and necessary expenses in the same taxable year. These include only those expenses necessary for the production or collection of the rental income and they must be deducted when paid, not when they are incurred. Some examples of deductible expenses are interest on debts, State and local taxes on real and personal property and on motor fuels, general sales taxes, and expenses of managing or maintaining the property. (Sections 163, 164, and 212 of the Internal Revenue Code of 1954 … | ||||
| 20:20:2.0.1.1.9.11.423.11 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1123 How we count unearned income. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 47 FR 4988, Feb. 3, 1982; 47 FR 13794, Apr. 1, 1982; 50 FR 48574, Nov. 26, 1985; 55 FR 20599, May 18, 1990; 56 FR 3212, Jan. 29, 1991; 59 FR 59364, Nov. 17, 1994; 60 FR 8152, Feb. 10, 1995; 71 FR 45378, Aug. 9, 2006] | (a) When we count unearned income. We count unearned income at the earliest of the following points: when you receive it or when it is credited to your account or set aside for your use. We determine your unearned income for each month. We describe exceptions to the rule on how we count unearned income in paragraphs (d), (e) and (f) of this section. (b) Amount considered as income. We may include more or less of your unearned income than you actually receive. (1) We include more than you actually receive where another benefit payment (such as a social security insurance benefit) (see § 416.1121) has been reduced to recover a previous overpayment. You are repaying a legal obligation through the withholding of portions of your benefit amount, and the amount of the debt reduction is also part of your unearned income. Exception: We do not include more than you actually receive if you received both SSI benefits and the other benefit at the time the overpayment of the other benefit occurred and the overpaid amount was included in figuring your SSI benefit at that time. (2) We also include more than you actually receive if amounts are withheld from unearned income because of a garnishment, or to pay a debt or other legal obligation, or to make any other payment such as payment of your Medicare premiums. (3) We include less than you actually receive if part of the payment is for an expense you had in getting the payment. For example, if you are paid for damages you receive in an accident, we subtract from the amount of the payment your medical, legal, or other expenses connected with the accident. If you receive a retroactive check from a benefit program other than SSI, legal fees connected with the claim are subtracted. We do not subtract from any taxable unearned income the part you have to use to pay personal income taxes. The payment of taxes is not an expense you have in getting income. (4) In certain situations, we may consider someone else's income to be available to you, whether or not it actually is. … | ||||
| 20:20:2.0.1.1.9.11.423.12 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1124 Unearned income we do not count. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 47 FR 55213, Dec. 8, 1982; 48 FR 21943, May 16, 1983; 48 FR 33258, July 21, 1983; 48 FR 57127, Dec. 28, 1983; 50 FR 48574, Nov. 26, 1985; 51 FR 39523, Oct. 29, 1986; 54 FR 19164, May 4, 1989; 55 FR 28378, July 11, 1990; 57 FR 1384, Jan. 14, 1992; 57 FR 53850, Nov. 13, 1992; 58 FR 63888, Dec. 3, 1993; 61 FR 1712, Jan. 23, 1996; 61 FR 49964, Sept. 24, 1996; 61 FR 67207, Dec. 20, 1996; 70 FR 6345, Feb. 7, 2005; 70 FR 41137, July 18, 2005; 71 FR 45378, Aug. 9, 2006; 75 FR 7554, Feb. 22, 2010; 75 FR 54287, Sept. 7, 2010] | (a) General. While we must know the source and amount of all of your unearned income for SSI, we do not count all of it to determine your eligibility and benefit amount. We first exclude income as authorized by other Federal laws (see paragraph (b) of this section). Then we apply the other exclusions in the order listed in paragraph (c) of this section to the rest of your unearned income in the month. We never reduce your unearned income below zero or apply any unused unearned income exclusion to earned income except for the $20 general exclusion described in paragraph (c)(12) of this section. (b) Other Federal laws. Some Federal laws other than the Social Security Act provide that we cannot count some of your unearned income for SSI purposes. We list the laws and the exclusions in the appendix to this subpart which we update periodically. (c) Other unearned income we do not count. We do not count as unearned income— (1) Any public agency's refund of taxes on real property or food; (2) Assistance based on need which is wholly funded by a State or one of its political subdivisions. (For purposes of this rule, an Indian tribe is considered a political subdivision of a State.) Assistance is based on need when it is provided under a program which uses the amount of your income as one factor to determine your eligibility. Assistance based on need includes State supplementation of Federal SSI benefits as defined in subpart T of this part but does not include payments under a Federal/State grant program such as Temporary Assistance for Needy Families under title IV-A of the Social Security Act; (3) Any portion of a grant, scholarship, fellowship, or gift used or set aside for paying tuition, fees, or other necessary educational expenses. However, we do count any portion set aside or actually used for food or shelter; (4) Food which you or your spouse raise if it is consumed by you or your household; (5) Assistance received under the Disaster Relief and Emergency Assistance Act and assistance provided under … | ||||
| 20:20:2.0.1.1.9.11.423.9 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1120 What is unearned income. | SSA | Unearned income is all income that is not earned income. We describe some of the types of unearned income in § 416.1121. We consider all of these items as unearned income, whether you receive them in cash or in kind. | |||||
| 20:20:2.0.1.1.9.11.424.13 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1130 Introduction. | SSA | [89 FR 21209, Mar. 27, 2024, as amended at 89 FR 25514, Apr. 11, 2024] | (a) General. Both earned income and unearned income include items received in- kind (see § 416.1102). Generally, we value in-kind items at their current market value, and we apply the various exclusions for both earned and unearned income. However, we have special rules for valuing shelter that is received as in-kind support and maintenance (a type of unearned income). This section and the ones that follow discuss these rules. In these sections ( i.e., §§ 416.1130 through 416.1148) we use the in-kind support and maintenance you receive in the month as described in § 416.420 to determine your SSI benefit. We value the in-kind support and maintenance using the Federal benefit rate for the month in which you receive it. Exception: For the first 2 months for which a cost-of-living adjustment applies, we value in-kind support and maintenance you receive using the VTR or PMV based on the Federal benefit rate as increased by the cost-of-living adjustment. Example: Mr. Jones resides in his son's house and receives all of his meals from his son. Mr. Jones receives a monthly SSI Federal benefit rate that is reduced by one-third. This one-third represents the value of the in-kind support and maintenance he receives because he lives, throughout a month, in the household of his son, who provides all of his food and shelter. In January, we increase his SSI benefit because of a cost-of-living adjustment. For that month, we determine that the VTR rule applies by considering the food and shelter he received from his son two months earlier in November, and we calculate the SSI payment using the Federal benefit rate for January. (b) How we calculate in-kind support and maintenance. (1) We calculate in-kind support and maintenance considering any shelter that is given to you or that you receive because someone else pays for it. Shelter includes room, rent, mortgage payments, real property taxes, heating fuel, gas, electricity, water, sewerage, and garbage collection services. You are not receiving in-kind support and m… | ||||
| 20:20:2.0.1.1.9.11.424.14 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1131 The one-third reduction rule. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48574, Nov. 26, 1985; 89 FR 21210, Mar. 27, 2024] | (a) What the rule is. Instead of determining the actual dollar value of in-kind support and maintenance, we count one-third of the Federal benefit rate as additional income if you (or you and your eligible spouse)— (1) Live in another person's household (see § 416.1132) for a full calendar month except for temporary absences (see § 416.1149); and (2) Receive shelter from others living in the household. (If you do not receive shelter from others living in the household, see § 416.1140); and (3) Others within the household pay for or provide you with all of your meals. If others within the household do not pay for or provide you with all of your meals, any ISM received for shelter will be calculated under the PMV rule (see § 416.1140). (b) How we apply the one-third reduction rule. The one-third reduction applies in full or not at all. When you are living in another person's household, and the one-third reduction rule applies, we do not apply any income exclusions to the reduction amount. However, we do apply appropriate exclusions to any other earned or unearned income you receive. If you have an eligible spouse we apply the rules described in § 416.1147. (c) If you receive other support and maintenance. If the one-third reduction rule applies to you, we do not count any other in-kind support and maintenance you receive. | ||||
| 20:20:2.0.1.1.9.11.424.15 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1132 What we mean by “living in another person's household”. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48574, Nov. 26, 1985] | (a) Household. For purposes of this subpart, we consider a household to be a personal place of residence. A commercial establishment such as a hotel or boarding house is not a household but a household can exist within a commercial establishment. If you live in a commercial establishment, we do not automatically consider you to be a member of the household of the proprietor. You may, however, live in the household of a roomer or boarder within the hotel or boarding house. An institution is not a household and a household cannot exist within an institution. (Institution is defined in § 416.1101.) (b) Another person's household. You live in another person's household if paragraph (c) of this section does not apply and if the person who supplies the support and maintenance lives in the same household and is not— (1) Your spouse (as defined in § 416.1806); (2) A minor child; or (3) An ineligible person (your spouse, parent, or essential person) whose income may be deemed to you as described in §§ 416.1160 through 416.1169. (c) Your own household—not another person's household. You are not living in another person's household (you live in your own household) if— (1) You (or your spouse who lives with you or any person whose income is deemed to you) have an ownership interest or a life estate interest in the home; (2) You (or your spouse who lives with you or any person whose income is deemed to you) are liable to the landlord for payment of any part of the rental charges; (3) You live in a noninstitutional care situation as described in § 416.1143; (4) You pay at least a pro rata share of household and operating expenses (see § 416.1133); or (5) All members of the household receive public income—maintenance payments (§ 416.1142). | ||||
| 20:20:2.0.1.1.9.11.424.16 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1133 What is a pro rata share of household operating expenses. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 70 FR 6345, Feb. 7, 2005; 89 FR 21210, Mar. 27, 2024] | (a) General. If you pay your pro rata share toward monthly household operating expenses, you are living in your own household and are not receiving in-kind support and maintenance from anyone else in the household. The one-third reduction, therefore, does not apply to you. (If you are receiving shelter from someone outside the household, we value it under the rule in § 416.1140.) (b) How we determine a pro rata share. Your pro rata share of household operating expenses is the average monthly household operating expenses (based on a reasonable estimate if exact figures are not available) divided by the number of people in the household, regardless of age. (c) Household operating expenses are the household's total monthly expenditures for rent, mortgage, property taxes, heating fuel, gas, electricity, water, sewerage, and garbage collection service. (The term does not include the cost of these items if someone outside the household pays for them.) Generally, we average household operating expenses over the past 12 months to determine a pro rata share. | ||||
| 20:20:2.0.1.1.9.11.424.17 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1140 The presumed value rule. | SSA | [89 FR 21210, Mar. 27, 2024] | (a) How we apply the presumed value rule. (1) When you receive in-kind support and maintenance and the one-third reduction rule does not apply, we use the presumed value rule. Instead of determining the actual dollar value of any shelter you receive, we presume that it is worth a maximum value. This maximum value is one-third of your Federal benefit rate plus the amount of the general income exclusion described in § 416.1124(c)(12). (2) The presumed value rule allows you to show that your in-kind support and maintenance is not equal to the presumed value. We will not use the presumed value if you show us that— (i) The current market value of any shelter you receive, minus any payment you make for it, is lower than the presumed value; or (ii) The actual amount someone else pays for your shelter is lower than the presumed value. (b) How we determine the amount of your ISM under the presumed value rule. (1) If you choose not to question the use of the presumed value, or if the presumed value is less than the actual value of the shelter you receive, we use the presumed value to figure your ISM. (2) If you show us, as provided in paragraph (a)(2) of this section, that the presumed value is higher than the actual value of the shelter you receive, we use the actual amount to figure your ISM. | ||||
| 20:20:2.0.1.1.9.11.424.18 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1141 When the presumed value rule applies. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 89 FR 21210, Mar. 27, 2024] | The presumed value rule applies whenever we count in-kind support and maintenance as unearned income and the one-third reduction rule does not apply. This means that the presumed value rule applies if you are living— (a) In another person's household (as described in § 416.1132(b)); you receive shelter from others living in the household; and others within the household do not pay for or provide you with all of your meals; (b) In your own household (as described in § 416.1132(c)). For exceptions, see § 416.1142 if you are in a public assistance household and § 416.1143 if you are in a noninstitutional case situation; or (c) In a nonmedical institution including any— (1) Public nonmedical institution if you are there for less than a full calendar month; (2) Public or private nonprofit educational or vocational training institution; (3) Private nonprofit retirement home or similar institution where there is an express obligation to provide your full support and maintenance or where someone else pays for your support and maintenance. For exceptions, see § 416.1144; and (4) For-profit institution where someone else pays for your support and maintenance. If you or the institution pay for it, see § 416.1145. | ||||
| 20:20:2.0.1.1.9.11.424.19 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1142 If you live in a public assistance household. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 57 FR 53850, Nov. 13, 1992; 70 FR 6345, Feb. 7, 2005; 70 FR 41137, July 18, 2005; 89 FR 28622, Apr. 19, 2024] | (a) Definition. For purposes of our programs, a public assistance household is one that has both an SSI applicant or recipient, and at least one other household member who receives one or more of the listed public income maintenance payments. These are payments made under— (1) Title IV-A of the Social Security Act (Temporary Assistance for Needy Families); (2) Title XVI of the Social Security Act (SSI, including federally administered State supplements and State administered mandatory supplements); (3) The Refugee Act of 1980 (Those payments based on need); (4) The Disaster Relief and Emergency Assistance Act; (5) General assistance programs of the Bureau of Indian Affairs; (6) State or local government assistance programs based on need (tax credits or refunds are not assistance based on need); (7) U.S. Department of Veterans Affairs programs (those payments based on need); and (8) The Supplemental Nutrition Assistance Program (SNAP). (b) How the presumed value rule applies. If you live in a public assistance household, we consider that you are not receiving in-kind support and maintenance from members of the household. In this situation, we use the presumed value rule only if you receive food or shelter from someone outside the household. | ||||
| 20:20:2.0.1.1.9.11.424.20 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1143 If you live in a noninstitutional care situation. | SSA | (a) Definitions. For purposes of this subpart you live in a noninstitutional care situation if all the following conditions exist: (1) You are placed by a public or private agency under a specific program such as foster or family care; (2) The placing agency is responsible for your care; (3) You are in a private household (not an institution) which is licensed or approved by the placing agency to provide care; and (4) You, a public agency, or someone else pays for your care. (b) How the presumed value rule applies. You are not receiving in-kind support and maintenance and the presumed value rule does not apply if you pay the rate the placing agency establishes. We consider this established rate to be the current market value for the in-kind support and maintenance you are receiving. The presumed value rule applies if you pay less than the established rate and the difference is paid by someone else other than a public or private agency providing social services described in § 416.1103(b) or assistance based on need described in § 416.1124(c)(2). | |||||
| 20:20:2.0.1.1.9.11.424.21 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1144 If you live in a nonprofit retirement home or similar institution. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 51 FR 34464, Sept. 29, 1986; 70 FR 6345, Feb. 7, 2005] | (a) Definitions. For purposes of this section the following definitions apply: (1) Nonprofit retirement home or similar institution means a nongovernmental institution as defined under § 416.1101, which is, or is controlled by, a private nonprofit organization and which does not provide you with— (i) Services which are (or could be) covered under Medicaid, or (ii) Education or vocational training. (2) Nonprofit organization means a private organization which is tax exempt under section 501(a) of the Internal Revenue Code of 1954 and is of the kind described in section 501 (c) or (d) of that code. (3) An express obligation to provide your full support and maintenance means there is either a legally enforceable written contract or set of membership rules providing that the home, institution, or organization— (i) Will provide at least all of your food and shelter needs; and (ii) Does not require any current or future payment for that food and shelter. (For purposes of this paragraph, a lump sum prepayment for lifetime care is not a current payment.) (b) How the presumed value rule applies. The presumed value rule applies if you are living in a nonprofit retirement home or similar institution where there is an express obligation to provide your full support and maintenance or where someone else pays for your support and maintenance. The rule does not apply to the extent that— (1) The home, institution, or nonprofit organization does not have an express obligation to provide your full support and maintenance; and (2) The home, institution, or nonprofit organization receives no payment for your food or shelter, or receives payment from another nonprofit organization. | ||||
| 20:20:2.0.1.1.9.11.424.22 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1145 How the presumed value rule applies in a nonmedical for-profit institution. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 70 FR 6345, Feb. 7, 2005] | If you live in a nonmedical for-profit institution, we consider the amount accepted by that institution as payment in full to be the current market value of whatever food or shelter the institution provides. If you are paying or are legally indebted for that amount, you are not receiving in-kind support and maintenance. We do not use the presumed value rule unless someone else pays for you. | ||||
| 20:20:2.0.1.1.9.11.425.23 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1147 How we value in-kind support and maintenance for a couple. | SSA | [60 FR 16375, Mar. 30, 1995, as amended at 61 FR 10279, Mar. 13, 1996; 70 FR 6345, Feb. 7, 2005; 89 FR 21210, Mar. 27, 2024] | (a) Both members of a couple live in another person's household and receive shelter and all of their meals from others living in the household. When both of you live in another person's household throughout a month, receive shelter from others living in the household, and others within the household pay for or provide you with all of your meals, we apply the one-third reduction to the Federal benefit rate for a couple (§ 416.1131). (b) One member of a couple is in a medical institution and the other member of the couple lives in another person's household and receives shelter and all of their meals from others living in the household. (1) If one of you is living in the household of another person and receives shelter from others living in the household, and others within the household pay for or provide you with all of your meals, and the other is temporarily absent from the household as provided in § 416.1149(c)(1) (in a medical institution that receives substantial Medicaid payments for their care (§ 416.211(b))), and is ineligible in the month for either benefit payable under § 416.212, we compute your benefits as if you were separately eligible individuals (see § 416.414(b)(3)). This begins with the first full calendar month that one of you is in the medical institution. The one living in another person's household is eligible at an eligible individual's Federal benefit rate and one-third of that rate is counted as income not subject to any income exclusions. The one in the medical institution cannot receive more than the reduced benefit described in § 416.414(b)(3)(i). (2) If the one member of the couple in the institution is eligible for one of the benefits payable under the § 416.212 provisions, we compute benefits as a couple at the rate specified under § 416.412. However, if that one member remains in the institution for a full month after expiration of the period benefits based on § 416.212 can be paid, benefits will be computed as if each person were separately eligible as described under paragra… | ||||
| 20:20:2.0.1.1.9.11.425.24 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1147a Income rules in change-of-status situations involving in-kind support and maintenance. | SSA | [50 FR 48575, Nov. 26, 1985] | (a) General. This section explains the rules for determining countable income, including in-kind support and maintenance, when eligible individuals become an eligible couple or when an eligible couple becomes eligible individuals. Generally, under retrospective monthly accounting, income in a prior month, including in-kind support and maintenance, affects benefit amounts for a current month. The prior month may be the first or second month prior to the current month (as explained in § 416.420(a)) and the rules in this section apply when a change-of-status becomes effective between the prior month and the current month. (b) Eligible individuals become an eligible couple. If you and your spouse have been eligible individuals and become an eligible couple, we combine the earned and unearned income each of you had as an eligible individual in the prior month. If either or both of you received in-kind support and maintenance, we include its value as income. This may be one-third of the Federal benefit rate that applied in the prior month for one or both of you who lived in the household of another. It may be the presumed maximum value (one-third of the Federal benefit rate plus $20 as explained in § 416.1140) for one or both of you as appropriate. It may also be a combination of the two if each of you received income in one of these forms. We also include income deemed to either or both of you in the prior month. (c) Eligible couple becomes one or two eligible individuals. If you are an eligible individual in the current month but were a member of an eligible couple in the prior month, we determine your countable income in the prior month separately from that of your spouse. We determine the value of any in-kind support and maintenance you and your spouse received in the prior month using the rules contained in § 416.1147. For example, if both of you lived in the household of another and the one-third reduction applied, each of you would have income equal to one-sixth of the Federal benefit rate for a couple. … | ||||
| 20:20:2.0.1.1.9.11.425.25 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1148 If you have both in-kind support and maintenance and income that is deemed to you. | SSA | [60 FR 361, Jan. 4, 1995, as amended at 70 FR 6345, Feb. 7, 2005; 89 FR 21211, Mar. 27, 2024] | (a) The one-third reduction and deeming of income. If you live in the household of your spouse, parent, essential person, or sponsor whose income can be deemed to you, or the household of a parent whose income is not deemed to you because of the provisions of § 416.1165(i), the one-third reduction does not apply to you. The rules on deeming income are in §§ 416.1160 through 416.1169. However, if you live in another person's household as described in § 416.1131, and someone whose income can be deemed to you lives in the same household, we must apply both the one-third reduction and the deeming rules to you. (b) The presumed value rule and deeming of income. (1) If you live in the same household with someone whose income can be deemed to you (§§ 416.1160 through 416.1169), or with a parent whose income is not deemed to you because of the provisions of § 416.1165(i), any shelter that person provides is not income to you. However, if you receive any shelter from another source, it is income and we value it under the presumed value rule (§ 416.1140). We also apply the deeming rules. (2) If you are a child under age 18 who lives in the same household with an ineligible parent whose income may be deemed to you, and you are temporarily absent from the household to attend school (§ 416.1167(b)), any shelter you receive at school is income to you unless your parent purchases it. Unless otherwise excluded, we value this income under the presumed value rule (§ 416.1140). We also apply the deeming rules to you (§ 416.1165). | ||||
| 20:20:2.0.1.1.9.11.426.26 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1149 What is a temporary absence from your living arrangement. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48575, Nov. 26, 1985; 52 FR 8882, Mar. 20, 1987; 61 FR 10279, Mar. 13, 1996; 62 FR 1056, Jan. 8, 1997; 70 FR 6345, Feb. 7, 2005; 72 FR 50874, Sept. 5, 2007; 89 FR 21211, Mar. 27, 2024] | (a) General. A temporary absence may be due to employment, hospitalization, vacations, or visits. The length of time an absence can be temporary varies depending on the reason for your absence. For purposes of valuing in-kind support and maintenance under §§ 416.1130 through 416.1148, we apply the rules in this section. In general, we will find a temporary absence from your permanent living arrangement if you (or you and your eligible spouse)— (1) Become a resident of a public institution, or a public or private medical treatment facility where you otherwise would be subject to the reduced benefit rate described in § 416.414, and you are eligible for the benefits payable under § 416.212; or (2) Were in your permanent living arrangement for at least 1 full calendar month prior to the absence and intend to, and do, return to your permanent living arrangement in the same calendar month in which you (or you and your spouse) leave, or in the next month. (b) Rules we apply during a temporary absence. During a temporary absence, we continue to value your support and maintenance the same way that we did in your permanent living arrangement. For example, if the one-third reduction applies in your permanent living arrangement, we continue to apply the same rule during a temporary absence. However, if you receive in-kind support and maintenance only during a temporary absence we do not count it since you are still responsible for maintaining your permanent quarters during the absence. (c) Rules for temporary absence in certain circumstances. (1)(i) If you enter a medical treatment facility where you are eligible for the reduced benefits payable under § 416.414 for full months in the facility, and you are not eligible for either benefit payable under § 416.212 (and you have not received such benefits during your current period of confinement) and you intend to return to your prior living arrangement, we consider this a temporary absence regardless of the length of your stay in the facility. We use the rules that ap… | ||||
| 20:20:2.0.1.1.9.11.427.27 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1150 How we treat income received because of a major disaster. | SSA | [57 FR 53850, Nov. 13, 1992] | (a) General. The Disaster Relief and Emergency Assistance Act and other Federal statutes provide assistance to victims of major disasters. In this section we describe when we do not count certain kinds of assistance you receive under these statutes. (b) Support and maintenance. (1) We do not count the value of support and maintenance (in cash or in kind) received from a Federal, State, or local government source, or from a disaster assistance organization, and the one-third reduction rule does not apply if— (i) You live in a household which you or you and another person maintain as your home when a catastrophe occurs in the area; (ii) The President of the United States declares the catastrophe to be a major disaster for purposes of the Disaster Relief and Emergency Assistance Act; (iii) You stop living in the home because of the catastrophe and within 30 days after the catastrophe you begin to receive support and maintenance; and (iv) You receive the support and maintenance while living in a residential facility maintained by another person. (2) We do not count the value of support and maintenance (in cash or in kind) received from any other source, such as from a private household, and the one-third reduction rule does not apply for up to 18 months after you begin to receive it if— (i) You live in a household which you or you and another person maintain as your home when a catastrophe occurs in the area; (ii) The President of the United States declares the catastrophe to be a major disaster for purposes of the Disaster Relief and Emergency Assistance Act; (iii) You stop living in the home because of the catastrophe and within 30 days after the catastrophe you begin to receive support and maintenance; and (iv) You receive the support and maintenance while living in a residential facility (including a private household) maintained by another person. (c) Other assistance you receive. We do not consider other assistance to be income if you receive it under the Disaster Relief and Emergency Assistanc… | ||||
| 20:20:2.0.1.1.9.11.427.28 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1151 How we treat the repair or replacement of lost, damaged, or stolen resources. | SSA | (a) General rule. If a resource is lost, damaged, or stolen, you may receive cash to repair or replace it or the resource may be repaired or replaced for you. We do not count the cash or the repair or replacement of the resource as your income. (b) Interest on cash for repair or replacement of a noncash resource. We do not count any interest earned on the cash you receive for repair or replacement of a noncash resource if the interest is earned within 9 months of the date you receive the cash. We can extend the 9-month period for up to an additional 9 months if we find you have good cause for not repairing or replacing the resource within the initial period. Good cause exists, for example, if you show that circumstances beyond your control prevent the repair or replacement, or contracting for the repair or replacement, of the resource within the first 9-month period. (c) Temporary replacement of a damaged or destroyed home. In determining the amount of in-kind support and maintenance you receive (§§ 416.1130 through 416.1140), we do not count temporary housing if— (1) Your excluded home is damaged or destroyed, and (2) You receive the temporary housing only until your home is repaired or replaced. | |||||
| 20:20:2.0.1.1.9.11.428.29 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1157 Support and maintenance assistance. | SSA | [51 FR 39523, Oct. 29, 1986; 51 FR 43709, Dec. 3, 1986, as amended at 53 FR 35808, Sept. 15, 1988; 70 FR 6345, Feb. 7, 2005] | (a) General. Section 2639 of Pub. L. 98-369, effective October 1, 1984, amended section 1612(b)(13) to provide that certain support and maintenance assistance, which includes home energy assistance, be excluded from countable income for SSI purposes. This section discusses how we apply section 1612(b)(13). (b) Definitions. For support and maintenance assistance purposes— Appropriate State agency means the agency designated by the chief executive officer of the State to handle the State's responsibilities as set out in paragraph (c) of this section. Based on need means that the provider of the assistance: (1) Does not have an express obligation to provide the assistance; (2) States that the aid is given for the purpose of support or maintenance assistance or for home energy assistance (e.g., vouchers for heating or cooling bills, storm doors); and (3) Provides the aid for an SSI claimant, a member of the household in which an SSI claimant lives or an SSI claimant's ineligible spouse, parent, sponsor (or the sponsor's spouse) of an alien, or essential person. Private nonprofit agency means a religious, charitable, educational, or other organization such as described in section 501(c) of the Internal Revenue Code of 1954. (Actual tax exempt certification by IRS is not necessary.) Rate-of-return entity means an entity whose revenues are primarily received from the entity's charges to the public for goods or services and such charges are based on rates regulated by a State or Federal governmental body. Support and maintenance assistance means cash provided for the purpose of meeting food or shelter needs or in-kind support and maintenance as defined in § 416.1121(h). Support and maintenance assistance includes home energy assistance. Home energy assistance means any assistance related to meeting the costs of heating or cooling a home. Home energy assistance includes such items as payments for utility service or bulk fuels; assistance in kind such as portable heaters, fans, blankets, storm doors, or o… | ||||
| 20:20:2.0.1.1.9.11.429.30 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1160 What is deeming of income? | SSA | [52 FR 8882, Mar. 20, 1987, as amended at 54 FR 19164, May 4, 1989; 64 FR 31974, June 15, 1999; 73 FR 28035, May 15, 2008; 75 FR 7554, Feb. 22, 2010] | (a) General. We use the term deeming to identify the process of considering another person's income to be your own. When the deeming rules apply, it does not matter whether the income of the other person is actually available to you. We must apply these rules anyway. There are four categories of individuals whose income may be deemed to you. (1) Ineligible spouse. If you live in the same household with your ineligible spouse, we look at your spouse's income to decide whether we must deem some of it to you. We do this because we expect your spouse to use some of his or her income to take care of some of your needs. (2) Ineligible parent. If you are a child to whom deeming rules apply (see § 416.1165), we look at your ineligible parent's income to decide whether we must deem some of it to be yours. If you live with both your parent and your parent's spouse ( i.e. , your stepparent), we also look at your stepparent's income to decide whether we must deem some of it to be yours. We do this because we expect your parent (and your stepparent, if living with you and your parent) to use some of his or her income to take care of your needs. (3) Sponsor of an alien. If you are an alien who has a sponsor and you first apply for SSI benefits after September 30, 1980, we look at your sponsor's income to decide whether we must deem some of it to be yours. This rule applies for 3 years after you are admitted to the United States for permanent residence and regardless of whether you live in the same household as your sponsor. We deem your sponsor's income to you because your sponsor agreed to support you (signed an affidavit of support) as a condition of your admission to the United States. If two deeming rules could apply to you because your sponsor is also your ineligible spouse or parent who lives with you, we use the appropriate spouse-to-spouse or parent-to-child deeming rules instead of the sponsor-to-alien rules. If you have a sponsor and also have an ineligible spouse or parent who is not your sponsor and whos… | ||||
| 20:20:2.0.1.1.9.11.429.31 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1161 Income of an ineligible spouse, ineligible parent, and essential person for deeming purposes. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 46 FR 57276, Nov. 23, 1981; 48 FR 33259, July 21, 1983; 50 FR 48576, Nov. 26, 1985; 51 FR 39523, Oct. 29, 1986; 52 FR 8883, Mar. 20, 1987; 52 FR 44971, Nov. 24, 1987; 55 FR 28378, July 11, 1990; 58 FR 63888, 63890, Dec. 3, 1993; 61 FR 1712, Jan. 23, 1996; 61 FR 49964, Sept. 24, 1996; 67 FR 11034, Mar. 12, 2002; 71 FR 45378, Aug. 9, 2006; 71 FR 66866, Nov. 17, 2006; 75 FR 7554, Feb. 22, 2010] | The first step in deeming is determining how much income your ineligible spouse, ineligible parent (if you are a child), your sponsor (if you are an alien), or your essential person, has. We do not always include all of their income when we determine how much income to deem. In this section we explain the rules for determining how much of their income is subject to deeming. As part of the process of deeming income from your ineligible spouse or parent, we must determine the amount of income of any ineligible children in the household. (a) For an ineligible spouse or parent. We do not include any of the following types of income (see § 416.1102) of an ineligible spouse or parent: (1) Income excluded by Federal laws other than the Social Security Act (See the appendix to this subpart.) (2) Any public income-maintenance payments (§ 416.1142(a)) your ineligible spouse or parent receives, and any income which was counted or excluded in figuring the amount of that payment; (3) Any of the income of your ineligible spouse or parent that is used by a public income-maintenance program (§ 416.1142(a)) to determine the amount of that program's benefit to someone else; (4) Any portion of a grant, scholarship, fellowship, or gift used or set aside to pay tuition, fees or other necessary educational expenses; (5) Money received for providing foster care to an ineligible child; (6) The value of food stamps and the value of Department of Agriculture donated foods; (7) Food raised by your parent or spouse and consumed by members of the household in which you live; (8) Tax refunds on income, real property, or food purchased by the family; (9) Income used to fulfill an approved plan for achieving self-support (see §§ 416.1180 through 416.1182); (10) Income used to comply with the terms of court-ordered support, or support payments enforced under title IV-D of the Act; (11) The value of in-kind support and maintenance; (12) Alaska Longevity Bonus payments made to an individual who is a resident of Alaska and who, prior… | ||||
| 20:20:2.0.1.1.9.11.429.32 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1161a Income for deeming purposes where Medicaid eligibility is affected. | SSA | [49 FR 5747, Feb. 15, 1984] | (a) General. In many States, an individual who is eligible for SSI or a Federally administered State optional supplementary payment is in turn eligible for Medicaid. Also, several other States use SSI deeming rules in determining eligibility for Medicaid. In all of these States, in extraordinary cases, the Department will not apply the usual rules on deeming of income where those rules would result in an individual's being ineligible for SSI (or a Federally administered State optional supplementary payment) and Medicaid. Any determination made under this section may at any time be revised based on new information or changed circumstances. (b) When special deeming rules apply: (1) The Department will consider not applying the usual deeming rules only upon application by a State Medicaid agency (requirement approved under OMB No. 0960-0304) and on condition that the agency must show: (i) Deeming would result in lack of Medicaid eligibility for the individual. (ii) Medicaid eligibility would, prospectively, result in savings to the Medicaid program; and (iii) The quality of medical care necessary for the individual would be maintained under the arrangements contemplated. (2) The Department may also in particular cases require that additional facts be demonstrated, or that other criteria or standards be met, before it determines not to apply the usual deeming rules. (c) Amount of income to be deemed. If the usual rules of deeming do not apply, the Department will determine an amount, if any, to be deemed. (d) Temporary effect of special deeming rules. This provision is temporary and will be continued only through December 31, 1984. Determinations made under this section will nevertheless remain in effect unless they are revised based on changed circumstances (including establishment in the State of a Medicaid program of home and community-based services or eligibility under a State plan provision) or new information. | ||||
| 20:20:2.0.1.1.9.11.429.33 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1163 How we deem income to you from your ineligible spouse. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48576, Nov. 26, 1985; 52 FR 8883, Mar. 20, 1987; 53 FR 25151, July 5, 1988; 54 FR 19164, May 4, 1989; 64 FR 31974, June 15, 1999] | If you have an ineligible spouse who lives in the same household, we apply the deeming rules to your ineligible spouse's income in the following order. (a) Determining your ineligible spouse's income. We first determine how much earned and unearned income your ineligible spouse has, using the appropriate exclusions in § 416.1161(a). (b) Allocations for ineligible children. We then deduct an allocation for ineligible children in the household to help meet their needs. Exception: We do not allocate for ineligible children who are receiving public income-maintenance payments (see § 416.1142(a)). (1) The allocation for each ineligible child is the difference between the Federal benefit rate for an eligible couple and the Federal benefit rate for an eligible individual. The amount of the allocation automatically increases whenever the Federal benefit rate increases. The amount of the allocation that we use to determine the amount of a benefit for a current month is based on the Federal benefit rate that applied in the second prior month unless one of the exceptions in § 416.1160(b)(2) applies. (2) Each ineligible child's allocation is reduced by the amount of his or her own income as described in § 416.1161(c). (3) We first deduct the allocations from your ineligible spouse's unearned income. If your ineligible spouse does not have enough unearned income to cover the allocations we deduct the balance from your ineligible spouse's earned income. (c) Allocations for aliens sponsored by your ineligible spouse. We also deduct an allocation for eligible aliens who have been sponsored by and who have income deemed from your ineligible spouse. (1) The allocation for each alien who is sponsored by and who has income deemed from your ineligible spouse is the difference between the Federal benefit rate for an eligible couple and the Federal benefit rate for an eligible individual. The amount of the allocation automatically increases whenever the Federal benefit rate increases. The amount of the allocation that we… | ||||
| 20:20:2.0.1.1.9.11.429.34 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1165 How we deem income to you from your ineligible parent(s). | SSA | [52 FR 8885, Mar. 20, 1987, as amended at 54 FR 19164, May 4, 1989; 57 FR 48562, Oct. 27, 1992; 60 FR 361, Jan. 4, 1995; 62 FR 1056, Jan. 8, 1997; 64 FR 31974, June 15, 1999; 72 FR 50874, Sept. 5, 2007; 73 FR 28036, May 15, 2008] | If you are a child living with your parents, we apply the deeming rules to you through the month in which you reach age 18. We follow the rules in paragraphs (a) through (e) of this section to determine your eligibility. To determine your benefit amount, we follow the rules in paragraph (f) of this section. The rules in paragraph (g) of this section apply to changes in your family situation. Paragraph (i) of this section discusses the conditions under which we will not deem your ineligible parents' income to you if you are a disabled child living with your parents. (a) Determining your ineligible parent's income. We first determine how much current monthly earned and unearned income your ineligible parents have, using the appropriate exclusions in § 416.1161(a). (b) Allocations for ineligible children. We next deduct an allocation for each ineligible child in the household as described in § 416.1163(b). (c) Allocations for aliens who are sponsored by and have income deemed from your ineligible parent. We also deduct an allocation for eligible aliens who have been sponsored by and have income deemed from your ineligible parent as described in § 416.1163(c). (d) Allocations for your ineligible parent(s). We next deduct allocations for your parent(s). We do not deduct an allocation for a parent who is receiving public income-maintenance payments (see § 416.1142(a)). The allocations are calculated as follows: (1) We first deduct $20 from the parents' combined unearned income, if any. If they have less than $20 in unearned income, we subtract the balance of the $20 from their combined earned income. (2) Next, we subtract $65 plus one-half the remainder of their earned income. (3) We total the remaining earned and unearned income and subtract— (i) The Federal benefit rate for the month for a couple if both parents live with you; or (ii) The Federal benefit rate for the month for an individual if only one parent lives with you. (e)(1) When you are the only eligible child. If you are the only eligible… | ||||
| 20:20:2.0.1.1.9.11.429.35 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1166 How we deem income to you and your eligible child from your ineligible spouse. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48578, Nov. 26, 1985; 52 FR 8887, Mar. 20, 1987; 64 FR 31975, June 15, 1999] | If you and your eligible child live in the same household with your ineligible spouse, we deem your ineligible spouse's income first to you, and then we deem any remainder to your eligible child. For the purpose of this section, SSI benefits include any federally administered State supplement. We then follow the rules in § 416.1165(e) to determine the child's eligibility for SSI benefits and in § 416.1165(f) to determine the benefit amount. (a) Determining your ineligible spouse's income. We first determine how much earned and unearned income your ineligible spouse has, using the appropriate exclusions in § 416.1161(a). (b) Allocations for ineligible children. We next deduct an allocation for each ineligible child in the household as described in § 416.1163(b). (c) Allocations for aliens who are sponsored by and have income deemed from your ineligible spouse. We also deduct an allocation for eligible aliens who have been sponsored by and have income deemed from your ineligible spouse as described in § 416.1163(c). (d) Determining your eligibility for SSI benefits and benefit amount. We then follow the rules in § 416.1163(c) to find out if any of your ineligible spouse's current monthly income is deemed to you and, if so, to determine countable income for a couple. Next, we follow paragraph (e) of this section to determine your child's eligibility. However, if none of your spouse's income is deemed to you, none is deemed to your child. Whether or not your spouse's income is deemed to you in determining your eligibility, we determine your benefit amount as explained in § 416.1163(e). (e) Determining your child's eligibility and amount of benefits. (1) If you are eligible for SSI benefits after your spouse's income has been deemed to you, we do not deem any income to your child. To determine the child's eligibility, we subtract the child's own countable income without deeming from the benefit rate for an individual. (2) If you are not eligible for SSI benefits after your ineligible spouse's income ha… | ||||
| 20:20:2.0.1.1.9.11.429.36 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1166a How we deem income to you from your sponsor if you are an alien. | SSA | [52 FR 8887, Mar. 20, 1987] | Before we deem your sponsor's income to you if you are an alien, we determine how much earned and unearned income your sponsor has under § 416.1161(b). We then deduct allocations for the sponsor and the sponsor's dependents. This is an amount equal to the Federal benefit rate for an individual for the sponsor (or for each sponsor even if two sponsors are married to each other and living together) plus an amount equal to one-half the Federal benefit rate for an eligible individual for each dependent of the sponsor. An ineligible dependent's income is not subtracted from the sponsor's dependent's allocation. We deem the balance of the income to be your unearned income. (a) If you are the only alien applying for or already eligible for SSI benefits who has income deemed to you from your sponsor. If you are the only alien who is applying for or already eligible for SSI benefits and who is sponsored by your sponsor, all the deemed income is your unearned income. (b) If you are not the only alien who is applying for or already eligible for SSI benefits and who has income deemed from your sponsor. If you and other aliens applying for or already eligible for SSI benefits are sponsored by the same sponsor, we deem the income to each of you as though you were the only alien sponsored by that person. The income deemed to you becomes your unearned income. (c) When you are an alien and income is no longer deemed from your sponsor. If you are an alien and have had your sponsor's income deemed to you, we stop deeming the income with the month in which the third anniversary of your admission into the United States occurs. (d) When sponsor deeming rules do not apply to you if you are an alien. If you are an alien, we do not apply the sponsor deeming rules to you if— (1) You are a refugee. You are a refugee admitted to the United States as the result of application of one of three sections of the Immigration and Nationality Act: (1) Section 203(a)(7), effective before April 1, 1980; (2) Section 207(c)(1), effective … | ||||
| 20:20:2.0.1.1.9.11.429.37 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1167 Temporary absences and deeming rules. | SSA | [50 FR 48579, Nov. 26, 1985, as amended at 61 FR 10280, Mar. 13, 1996; 62 FR 42411, Aug. 7, 1997; 72 FR 50874, Sept. 5, 2007] | (a) General. During a temporary absence, we continue to consider the absent person a member of the household. A temporary absence occurs when— (1) You, your ineligible spouse, parent, or an ineligible child leaves the household but intends to and does return in the same month or the month immediately following; or (2) You enter a medical treatment facility and are eligible for either benefit payable under § 416.212. We consider your absence to be temporary through the last month benefits under § 416.212 were paid unless you were discharged from the facility in the following month. In that case, we consider your absence to be temporary through the date of discharge. (b) Child away at school. If you are an eligible child who is away at school but comes home on some weekends or lengthy holidays and if you are subject to the control of your parents, we consider you temporarily absent from your parents' household. However, if you are not subject to parental control, we do not consider your absence temporary and we do not deem parental income (or resources) to you. Being subject to parental control affects deeming to you only if you are away at school. (c) Active duty military service. If your ineligible spouse or parent is absent from the household due solely to a duty assignment as a member of the Armed Forces on active duty, we continue to consider that person to be living in the same household as you, absent evidence to the contrary. If we determine that during such an absence, evidence indicates that your spouse or parent should no longer be considered to be living in the same household as you, then deeming will cease. When such evidence exists, we determine the month in which your spouse or parent should no longer be considered to be living in the same household as you and stop deeming his or her income and resources beginning with the month following that month. | ||||
| 20:20:2.0.1.1.9.11.429.38 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1168 How we deem income to you from your essential person. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48579, Nov. 26, 1985] | (a) Essential person's income. If you have an essential person, we deem all of that person's income (except any not counted because of other Federal statutes as described in § 416.1161(b)) to be your own unearned income. If your essential person is also your ineligible spouse, or if you are a child whose essential person is your ineligible parent, we apply the essential person deeming rules in this section. See § 416.1169 for the rules that apply when an ineligible spouse or parent ceases to be your essential person. (b) Determining your eligibility for an SSI benefit. We apply the exclusions to which you are entitled under §§ 416.1112 and 416.1124 to your earned income and to your unearned income which includes any income deemed from your essential person. After combining the remaining amounts of countable income, we compare the total with the Federal benefit rate for a qualified individual (see § 416.413) to determine whether you are eligible for an SSI benefit. (c) Determining your SSI benefit amount. We determine your SSI benefit amount in the same way that we determine your eligibility. However, in following the procedure in paragraphs (a) and (b) of this section we use your essential person's income that we deemed to you in the second month prior to the current month. Exception: Beginning with the month in which you no longer have your essential person, we do not use any of the income deemed to you from that essential person in a prior month to determine the amount of your benefit (see § 416.1160(a)(3)(ii)(C)). We use only your own countable income in a prior month. | ||||
| 20:20:2.0.1.1.9.11.429.39 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1169 When we stop deeming income from an essential person. | SSA | [50 FR 48579, Nov. 26, 1985] | If including the income deemed to you from your essential person causes you to be ineligible for an SSI benefit, you are no longer considered to have that essential person whose income makes you ineligible. To determine your eligibility for that month we deduct only your own countable income from your Federal benefit rate. However, other deeming rules may then apply as follows: (a) Essential person is your spouse. If the person who was your essential person is your ineligible spouse, we apply the deeming rules in § 416.1163 beginning with the month that the income of your essential person is no longer deemed to you. (b) Essential person is your parent. If you are a child under age 18, and the person who was your essential person is your ineligible parent, we apply the deeming rules in § 416.1165 beginning with the month that the income of your essential person is no longer deemed to you. | ||||
| 20:20:2.0.1.1.9.11.430.40 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1170 General. | SSA | (a) What the alternative is. If you are blind and meet the requirements in § 416.1171, we use one of two rules to see how much countable income you have. We use whichever of the following rules results in the lower amount of countable income: (1) The SSI income exclusions in §§ 416.1112 and 416.1124; or (2) The disregards that would have applied under the State plan for October 1972. (b) State plan. As used in this subpart, State plan for October 1972 means a State plan for providing assistance to the blind under title X or XVI (AABD) of the Social Security Act. That plan must have been approved under the provisions of 45 CFR chapter II as in effect for October 1972. | |||||
| 20:20:2.0.1.1.9.11.430.41 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1171 When the alternative rules apply. | SSA | (a) Eligibility for the alternative. We use the alternative income counting rules for you if you meet all the following conditions: (1) You were eligible for, and received, assistance for December 1973 under a State plan for October 1972; (2) You have continued to live in that same State since December 1973; (3) You were transferred to the SSI rolls and received a benefit for January 1974; and (4) You have not been ineligible for an SSI benefit for any period of more than 6 consecutive months. (For purposes of this section, an SSI benefit means a Federal benefit; it does not include any State supplementation.) (b) Living in the same State. For purposes of this section, you have continued to live in the same State since December 1973 unless you have left it at any time with the intention of moving to another State. If there is no evidence to the contrary, we assume that— (1) If you leave the State for 90 calendar days or less, the absence is temporary and you still live in that State; and (2) If you leave the State for more than 90 calendar days, you are no longer living there. | |||||
| 20:20:2.0.1.1.9.11.431.42 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1180 General. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 51 FR 10616, Mar. 28, 1986; 62 FR 59813, Nov. 5, 1997; 71 FR 28264, May 16, 2006] | One of the objectives of the SSI program is to help blind or disabled persons become self-supporting. If you are blind or disabled, we will pay you SSI benefits and will not count the part of your income (for example, your or a family member's wages, title II benefits, or pension income) that you use or set aside to use for expenses that we determine to be reasonable and necessary to fulfill an approved plan to achieve self-support. (See §§ 416.1112(c)(9) and 1124(c)(13).) You may develop a plan to achieve self-support on your own or with our help. As appropriate, we will refer you to a State rehabilitation agency or agency for the blind for additional assistance in developing a plan. | ||||
| 20:20:2.0.1.1.9.11.431.43 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1181 What is a plan to achieve self-support (PASS)? | SSA | [71 FR 28264, May 16, 2006] | (a) A PASS must— (1) Be designed especially for you; (2) Be in writing; (3) Be approved by us (a change of plan must also be approved by us); (4) Have a specific employment goal that is feasible for you, that is, a goal that you have a reasonable likelihood of achieving; (5) Have a plan to reach your employment goal that is viable and financially sustainable, that is, the plan— (i) Sets forth steps that are attainable in order to reach your goal, and (ii) Shows that you will have enough money to meet your living expenses while setting aside income or resources to reach your goal; (6) Be limited to one employment goal; however, the employment goal may be modified and any changes related to the modification must be made to the plan; (7) Show how the employment goal will generate sufficient earnings to substantially reduce or eliminate your dependence on SSI or eliminate your need for title II disability benefits; (8) Contain a beginning date and an ending date to meet your employment goal; (9) Give target dates for meeting milestones towards your employment goal; (10) Show what expenses you will have and how they are reasonable and necessary to meet your employment goal; (11) Show what money you have and will receive, how you will use or spend it to attain your employment goal, and how you will meet your living expenses; and (12) Show how the money you set aside under the plan will be kept separate from your other funds. (b) You must propose a reasonable ending date for your PASS. If necessary, we can help you establish an ending date, which may be different than the ending date you propose. Once the ending date is set and you begin your PASS, we may adjust or extend the ending date of your PASS based on progress towards your goal and earnings level reached. (c) If your employment goal is self-employment, you must include a business plan that defines the business, provides a marketing strategy, details financial data, outlines the operational procedures, and describes the management plan. (d) Your … | ||||
| 20:20:2.0.1.1.9.11.431.44 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | K | Subpart K—Income | § 416.1182 When we begin to count the income excluded under the plan. | SSA | [45 FR 65547, Oct. 3, 1980, as amended at 50 FR 48579, Nov. 26, 1985] | We will begin to count the earned and unearned income that would have been excluded under your plan in the month in which any of the following circumstances first exist: (a) You fail to follow the conditions of your plan; (b) You abandon your plan; (c) You complete the time schedule outlined in the plan; or (d) You reach your goal as outlined in the plan. | ||||
| 20:20:2.0.1.1.9.12.432.1 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | L | Subpart L—Resources and Exclusions | § 416.1201 Resources; general. | SSA | [40 FR 48915, Oct. 20, 1975, as amended at 44 FR 43266, July 24, 1979; 48 FR 33259, July 21, 1983; 52 FR 4283, Feb. 11, 1987; 52 FR 16845, May 6, 1987; 53 FR 23231, June 21, 1988; 56 FR 36001, July 30, 1991; 57 FR 35461, Aug. 10, 1992; 57 FR 55089, Nov. 24, 1992; 59 FR 27988, May 31, 1994] | (a) Resources; defined. For purposes of this subpart L, resources means cash or other liquid assets or any real or personal property that an individual (or spouse, if any) owns and could convert to cash to be used for his or her support and maintenance. (1) If the individual has the right, authority or power to liquidate the property or his or her share of the property, it is considered a resource. If a property right cannot be liquidated, the property will not be considered a resource of the individual (or spouse). (2) Support and maintenance assistance not counted as income under § 416.1157(c) will not be considered a resource. (3) Except for cash reimbursement of medical or social services expenses already paid for by the individual, cash received for medical or social services that is not income under § 416.1103 (a) or (b), or a retroactive cash payment which is income that is excluded from deeming under § 416.1161(a)(16), is not a resource for the calendar month following the month of its receipt. However, cash retained until the first moment of the second calendar month following its receipt is a resource at that time. (i) For purposes of this provision, a retroactive cash payment is one that is paid after the month in which it was due. (ii) This provision applies only to the unspent portion of those cash payments identified in this paragraph (a)(3). Once the cash from such payments is spent, this provision does not apply to items purchased with the money, even if the period described above has not expired. (iii) Unspent money from those cash payments identified in this paragraph (a)(3) must be identifiable from other resources for this provision to apply. The money may be commingled with other funds, but if this is done in such a fashion that an amount from such payments can no longer be separately identified, that amount will count toward the resource limit described in § 416.1205. (4) Death benefits, including gifts and inheritances, received by an individual, to the extent that they are not inc… | ||||
| 20:20:2.0.1.1.9.12.432.10 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | L | Subpart L—Resources and Exclusions | § 416.1212 Exclusion of the home. | SSA | [50 FR 42686, Oct. 22, 1985, as amended at 51 FR 7437, Mar. 4, 1986; 59 FR 43285, Aug. 23, 1994; 75 FR 1273, Jan. 11, 2010] | (a) Defined. A home is any property in which an individual (and spouse, if any) has an ownership interest and which serves as the individual's principal place of residence. This property includes the shelter in which an individual resides, the land on which the shelter is located and related outbuildings. (b) Home not counted. We do not count a home regardless of its value. However, see §§ 416.1220 through 416.1224 when there is an income-producing property located on the home property that does not qualify under the home exclusion. (c) If an individual changes principal place of residence. If an individual (and spouse, if any) moves out of his or her home without the intent to return, the home becomes a countable resource because it is no longer the individual's principal place of residence. If an individual leaves his or her home to live in an institution, we still consider the home to be the individual's principal place of residence, irrespective of the individual's intent to return, as long as a spouse or dependent relative of the eligible individual continues to live there. The individual's equity in the former home becomes a countable resource effective with the first day of the month following the month it is no longer his or her principal place of residence. (d) If an individual leaves the principal place of residence due to domestic abuse. If an individual moves out of his or her home without the intent to return, but is fleeing the home as a victim of domestic abuse, we will not count the home as a resource in determining the individual's eligibility to receive, or continue to receive, SSI payments. In that situation, we will consider the home to be the individual's principal place of residence until such time as the individual establishes a new principal place of residence or otherwise takes action rendering the home no longer excludable. (e) Proceeds from the sale of an excluded home. (1) The proceeds from the sale of a home which is excluded from the individual's resources will also be … | ||||
| 20:20:2.0.1.1.9.12.432.11 | 20 | Employees' Benefits | III | 416 | PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED | L | Subpart L—Resources and Exclusions | § 416.1216 Exclusion of household goods and personal effects. | SSA | [70 FR 6345, Feb. 7, 2005] | (a) Household goods. (1) We do not count household goods as a resource to an individual (and spouse, if any) if they are: (i) Items of personal property, found in or near the home, that are used on a regular basis; or (ii) Items needed by the householder for maintenance, use and occupancy of the premises as a home. (2) Such items include but are not limited to: Furniture, appliances, electronic equipment such as personal computers and television sets, carpets, cooking and eating utensils, and dishes. (b) Personal effects. (1) We do not count personal effects as resources to an individual (and spouse, if any) if they are: (i) Items of personal property ordinarily worn or carried by the individual; or (ii) Articles otherwise having an intimate relation to the individual. (2) Such items include but are not limited to: Personal jewelry including wedding and engagement rings, personal care items, prosthetic devices, and educational or recreational items such as books or musical instruments. We also do not count as resources items of cultural or religious significance to an individual and items required because of an individual's impairment. However, we do count items that were acquired or are held for their value or as an investment because we do not consider these to be personal effects. Such items can include but are not limited to: Gems, jewelry that is not worn or held for family significance, or collectibles. Such items will be subject to the limits in § 416.1205. |
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CREATE TABLE cfr_sections (
section_id TEXT PRIMARY KEY,
title_number INTEGER,
title_name TEXT,
chapter TEXT,
subchapter TEXT,
part_number TEXT,
part_name TEXT,
subpart TEXT,
subpart_name TEXT,
section_number TEXT,
section_heading TEXT,
agency TEXT,
authority TEXT,
source_citation TEXT,
amendment_citations TEXT,
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);
CREATE INDEX idx_cfr_title ON cfr_sections(title_number);
CREATE INDEX idx_cfr_part ON cfr_sections(part_number);
CREATE INDEX idx_cfr_agency ON cfr_sections(agency);