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Administrative Practice in the Social Security Administration (SSA)

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Administrative Practice in the Social Security Administration (SSA) What does SSA decide or adjudicate? Decisions as to the rights of any individual applying for a payment under Titles II, XVI and XVIII of the Social Security Act and the termination of such benefits. Retirement benefits, disability insurance and supplemental security income for disabled and blind adults, child disability (supplemental security income for disabled/blind minor children and disabled/blind adult children of retired or disabled individuals), disabled widow/er, survivor benefits, some Medicare eligibility (Social Security Act, Titles II, XVI and XVIII, in particular, sections 216, 223, 226, 226A, 210(p), 1634; 42 U.S.C. 401‐433, 1381‐1383f, 1395‐1395ccc) Social Security’s Definition of Disability: The inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months (40 U.S.C. 416(i)(1)(A), Social Security Act, section 216(i)(1)(A); 20 C.F.R. 404.1505, 416.905). Social Security’s Definition of Blindness: Central visual acuity of 20/200 or less in the better eye with the use of a correcting lens, or limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees (42 U.S.C. 416(i)(1)(B); Social Security Act, section 216(i)(1)(B); 20 C.F.R. 404.1581, 416.981). Disability for Adults: Five‐step sequential evaluation (20 C.F.R. 404.1520, 416.920) Disability for Children: Three‐step evaluation (20 C.F.R. 416.924, 416.924a, 416.924b, 416.925, 416.926) Disability Cessation/Termination: 8‐step sequential evaluation under Title II (20 C.F.R. 404.1594); 7‐step sequential evaluation under Title XVI (20 C.F.R. 416.994) Representation of Claimants and Beneficiaries Social Security Act, Section 206; 42 U.S.C. 406 20 CFR Part 404, Subpart R (20 C.F.R. 404.1700‐1799; 416.1500‐1599) Information for Representatives from SSA: https://www.ssa.gov/representation/index.htm Attorney and non‐attorney representatives permitted (20 C.F.R. 404.1705, 416.1505) Fees o Agreements or petitions o Must be authorized by SSA for services through the administrative review process NAPABA Washington DC Conference ‐ November 2017 Administrative Law Panel ‐ Social Security Administration (Page 1) o Possible direct payment of the lesser of up to 25% of the claimant’s past due benefits or maximum amount set by Commissioner (currently $6000) – initial claims only Mandatory use of electronic services if direct fee payment (20 C.F.R. 404.1713, 416.1513) Representative sanctions, suspension or removal, reinstatement – charges by Office of General Counsel, due process hearing before a hearing officer/Administrative Law Judge (ALJ), appeal/review by Appeals Council. Reinstatements decided by Appeals Council (20 C.F.R. 404.1750‐1799; 416.1550‐1599). Administrative Process – Social Security Act, Sections 205, 216, 221; 42 U.S.C. 405, 416. 421; 20 C.F.R. Part 404, Subpart J Initial Claims Termination of Benefits Initial Determination Initial Determination 20 C.F.R. 404.902‐905; 416.1402‐1405 20 C.F.R. 404.902‐905; 416.1402‐1405 60‐day appeal period 60‐day appeal period Reconsideration Determination Disability Hearing Officer determination 20 C.F.R. 404.907‐913, 404.919‐922; 20 C.F.R. 404.914‐918; 416.1414‐1418 416.1407‐1413a, 416.1419‐1422 60‐day appeal period 60‐day appeal period Hearing by Administrative Law Judge Hearing by Administrative Law Judge 20 C.F.R. 404.929‐961, 416.1429‐1461 20 C.F.R. 404.929‐961, 416.1429‐1461 HALLEX (Hearings and Appeals 60‐day appeal period Litigation Law) manual, Volume 1, Division 2, Chapters I‐2‐0 to I‐2‐10 60‐day appeal period Appellate and “own motion” review by Appellate and “own motion” review by Appeals Council Appeals Council 20 C.F.R. 404.967‐982, 416.1467‐1482 20 C.F.R. 404.967‐982, 416.1467‐1482 HALLEX, Volume 1, Division 3, Chapters 60‐day appeal period I‐3‐0 to I‐3‐10 60‐day appeal and own motion period Federal court review Federal court review 20 C.F.R. 404.982‐984, 416.1482‐1484 20 C.F.R. 404.982‐984, 416.1482‐1484 Expedited appeal to Federal court Expedited Appeal to Federal court 20 C.F.R. 404.923‐928, 416.1423‐1428 20 C.F.R. 404.923‐928, 416.1423‐1428 Reopening and revision – 20 C.F.R. 404.987‐404.989; 416.1487‐416.1489 NAPABA Washington DC Conference ‐ November 2017 Administrative Law Panel ‐ Social Security Administration (Page 2) Vol. 77 Friday, No. 222 November 16, 2012 Part IV Department of Labor Office of the Secretary Delegation of Authority and Assignment of Responsibility to the Administrative Review Board; Notice VerDate Mar<15>2010 16:54 Nov 15, 2012 Jkt 229001 PO 00000 Frm 00001 Fmt 4717 Sfmt 4717 E:\FR\FM\16NON3.SGM 16NON3 mstockstill on DSK4VPTVN1PROD with NOTICES3 69378 Federal Register / Vol. 77, No. 222 / Friday, November 16, 2012 / Notices DEPARTMENT OF LABOR (1) The Davis-Bacon Act, 40 U.S.C. (12) Equal Access to Justice Act, 5 § 3141 et seq.; any laws now existing or U.S.C. § 504; 29 CFR Part 16; Office of the Secretary which may be subsequently enacted, (13) Executive Order No. 11246, as providing for prevailing wages amended, 3 CFR part 339 (1964–1965 [Secretary’s Order 02–2012] determined by the Secretary of Labor in Comp.); reprinted in 42 U.S.C. 2000e accordance with or pursuant to the app.; 41 CFR Parts 60–1 and 60–30; Delegation of Authority and Davis-Bacon Act; the Contract Work (14) Fair Labor Standards Act of 1938, Assignment of Responsibility to the Hours and Safety Standards Act, 40 as amended, 29 U.S.C. 203(m); 29 CFR Administrative Review Board U.S.C. § 3701 et seq. (except matters Part 531, sections 531.4, 531.5; (15) Fair Labor Standards Act of 1938, 1. Purpose. To delegate authority and pertaining to safety); the Copeland Act, as amended, 29 U.S.C. 211(d); 29 CFR assign responsibility to the 40 U.S.C. § 3145; Reorganization Plan No. 14 of 1950; and 29 CFR parts 1, 3, Part 530, Subpart E; Administrative Review Board, define its (16) Fair Labor Standards Act of 1938, composition, and describe its functions. 5, 6, Subpart C and D. b. Final decisions of the as amended, 29 U.S.C. 214(c) 29 CFR 2. Authorities. This Order is issued Part 525, section 525.22; under the authority of 5 U.S.C. 301 Administrator of the Wage and Hour Division or an authorized representative (17) Fair Labor Standards Act of 1938, (Departmental Regulations); 29 U.S.C. as amended, 29 U.S.C. 216(e); 29 CFR of the Administrator, and decisions of 551 et seq. (Establishment of Part 580; ALJs, arising under the McNamara- Department; Secretary; Seal); (18) Fair Labor Standards Act of 1938, O’Hara Service Contract Act, as Reorganization Plan No. 6 1950 (5 as amended by the Affordable Care Act, amended, 41 U.S.C. § 6701 et seq.; the U.S.C. App. 1 Reorg. Plan 6 1950); and 29 U.S.C. 218C, Public Law 111–148, Contract Work Hours and Safety the authorities cited in Section 5 of this section 1558; Order. Standards Act, 40 U.S.C. § 3701 et seq. (19) Federal Railroad Safety Act, 49 3. Background. The Secretary of Labor (except matters pertaining to safety) U.S.C. § 20109; 29 CFR Part 1982; (‘‘Secretary’’) has the authority and where the contract is also subject to the (20) Federal Unemployment Tax Act, responsibility to decide certain appeals McNamara-O’Hara Service Contract Act; 26 U.S.C. 3303(b)(3), 3304(c); from administrative decisions. The and 29 CFR parts 4, 5, 6, Subparts B, D, (21) Federal Unemployment Tax Act Secretary created the Administrative E. (addressing agreements under the Trade Review Board (‘‘Board’’ or ‘‘ARB’’) in c. Decisions and recommended Act of 1974, as amended), 26 U.S.C. Secretary’s Order 02–96, which decisions by ALJs as provided for or 3302(c)(3); 20 CFR Part 617; delegated authority and assigned pursuant to the following laws and (22) Federal Water Pollution Control responsibilities to the Board. Secretary’s implementing regulations: Act, 33 U.S.C. 1367; 29 CFR Part 24; Order 01–2002 delegated this authority (1) Age Discrimination Act of 1975, 42 (23) Foreign Service Act of 1980, 22 and assigned responsibility to the ARB, U.S.C. § 6103; U.S.C. § 4117; 29 CFR Part 458, sections (2) Title VI of the Civil Rights Act of defined and expanded its composition, 458.70, 458.72, 458.76, 458.81, 458.82, 1964, 42 U.S.C. 2000d–l; 29 CFR Part clarified ARB procedural authorities, 458.88, 458.90, 459.91, 458.92, and 31; and codified the location of the ARB in 458.93; (3) Civil Service Reform Act of 1978, the Department’s organizational (24) Immigration and Nationality Act, 5 U.S.C. § 7120; 29 CFR Part 458, structure. Secretary’s Order 01–2010, as amended, 8 U.S.C. 1182(m); 20 CFR sections 458.70, 458.72, 458.76, 458.81, then, created and designated a Vice- Part 655, Subpart E; 458.82, 458.88, 458.90, 459.91, and Chair to maintain and operate the Board (25) Immigration and Nationality Act, 458.93; as amended, 8 U.S.C.
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