[Federal Register Volume 65, Number 38 (Friday, February 25, 2000)]
[Notices]
[Pages 10140-10142]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-4417]


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SOCIAL SECURITY ADMINISTRATION


Social Security Ruling, SSR 00-2p.--Titles II and XVI: Evaluation 
of Claims Involving the Issue of ``Similar Fault'' in the Providing of 
Evidence

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling.

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SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of 
Social Security gives notice of Social Security Ruling, SSR 00-2p. This 
Ruling sets forth the standards that we will apply at all levels of the 
administrative review process in determining whether there is reason to 
believe that ``similar fault'' was involved in providing evidence in 
connection with a claim for benefits. The Ruling sets forth the 
standards we will apply at all levels of adjudication pursuant to 
provisions of The Social Security Independence and Program Improvements 
Act of 1994 (Public Law 103-296), which amended sections 205 and 1631 
of the Social Security Act (the Act). This Ruling applies to all claims 
for benefits under title II and title XVI of the Act; i.e., claims for 
old-age and survivors benefits and disability benefits under title II 
of the Act, and claims for Supplemental Security Income benefits for 
the aged, blind, and disabled under title XVI.

EFFECTIVE DATE:  February 25, 2000.

FOR FURTHER INFORMATION CONTACT:  Len McMahon, Office of Disability, 
Division of Disability Process Policy, Social Security Administration, 
6401 Security Boulevard, Baltimore, MD 21235, (410) 965-9051.

SUPPLEMENTARY INFORMATION:  Although we are not required to do so 
pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this 
Social Security Ruling in accordance with 20 CFR 402.35(b)(1).
    Social Security Rulings make available to the public precedential 
decisions relating to the Federal old-age, survivors, disability, 
supplemental security income, and black lung benefits programs. Social 
Security Rulings may be based on case decisions made at all 
administrative levels of adjudication, Federal court decisions, 
Commissioner's decisions, opinions of the Office of the General 
Counsel, and policy interpretations of the law and regulations.
    Although Social Security Rulings do not have the same force and 
effect as the statute or regulations, they are binding on all 
components of the Social Security Administration, in accordance with 20 
CFR 402.35(b)(1), and are to be relied upon as precedents in 
adjudicating cases.
    If this Social Security Ruling is later superseded, modified, or 
rescinded, we will publish a notice in the Federal Register to that 
effect.

(Catalog of Federal Domestic Assistance, Programs 96.001 Social 
Security--Disability Insurance; 96.002 Social Security--Retirement 
Insurance; 96.003 Social Security--Special Benefits for Persons Aged 
72 and Over; 96.004 Social Security--Survivors Insurance; 96.005 
Special Benefits for Disabled Coal Miners; 96.006 Supplemental 
Security Income)


    February 2, 2000.
Kenneth S. Apfel,
Commissioner of Social Security.

Policy Interpretation Ruling--Titles II and XVI: Evaluation of 
Claims Involving the Issue of ``Similar Fault'' in the Providing of 
Evidence

    Purpose: To explain the rules that govern the evaluation and 
adjudication of claims when there is reason to believe that ``similar 
fault'' was involved in the providing of evidence in support of the 
claim.
    Citations (authority): Sections 205(u) and 1631(e)(7) of the Social 
Security Act, as amended; Regulations No. 4, sections 404.704, 404.708, 
404.1512, 404.1520, and 404.1527; Regulations No. 16, sections 416.912, 
416.920 416.924, and 416.927; and Regulations No. 22, section 
422.130(b).
    Introduction: The Social Security Independence and Program 
Improvements Act of 1994, Public Law 103-296, amended the Social 
Security

[[Page 10141]]

Act (the Act) concerning fraud or similar fault. These amendments to 
sections 205 and 1631 of the Act provide that the Social Security 
Administration (SSA) shall immediately redetermine an individual's 
entitlement to monthly insurance benefits under title II or eligibility 
for benefits under title XVI if there is reason to believe that fraud 
or similar fault was involved in the individual's application for such 
benefits. This legislation further provides that, when redetermining 
entitlement or eligibility, or when making an initial determination of 
entitlement or eligibility, SSA ``shall disregard any evidence if there 
is reason to believe that fraud or similar fault was involved in the 
providing of such evidence.''
    This Ruling sets forth the standards we (SSA and State agency 
adjudicators) will apply at all levels of the administrative review 
process in determining whether there is reason to believe that 
``similar fault'' was involved in providing evidence in connection with 
a claim for benefits. It also provides guidance for the evaluation of 
such claims when there is reason to believe that ``similar fault'' was 
involved. It applies to all claims for benefits under title II and 
title XVI of the Act; i.e., claims for old-age and survivors benefits 
and disability benefits under title II of the Act, and claims for 
Supplemental Security Income benefits for the aged, blind, and disabled 
under title XVI.
    This Ruling does not replace or limit other appropriate standards 
and criteria for development and evaluation of claims. There may be 
instances in which evidence will not be disregarded under the statutory 
provisions discussed in this Ruling, but factors nevertheless may exist 
that justify giving the evidence in question less credence than other 
evidence. For example, in disability claims such standards frequently 
include those set forth in 20 CFR 404.1527 and 416.927 for evaluating 
medical opinions, and those set forth in Social Security Ruling (SSR) 
96-7p, ``Titles II and XVI: Evaluation of Symptoms in Disability 
Claims: Assessing the Credibility of an Individual's Statements.''

Interpretation

General

    1. Sections 205(u) and 1631(e)(7) of the Act provide that evidence 
shall be disregarded if there is reason to believe that fraud or 
similar fault was involved in the providing of that evidence. These 
sections explain that ``similar fault'' is involved if: ``(A) an 
incorrect or incomplete statement that is material to the determination 
is knowingly made; or (B) information that is material to the 
determination is knowingly concealed.''
    2. Adjudicators may disregard evidence based on ``similar fault'' 
of a claimant, a recipient of benefits, or any other person connected 
with the claim. The other person need not have any direct relationship 
to the claimant or recipient, or be acting on behalf of the claimant or 
recipient.
    3. A ``similar fault'' finding can be made only if there is reason 
to believe, based on a preponderance of the evidence, that the person 
committing the fault knew that the evidence provided was false or 
incomplete. A ``similar fault'' finding cannot be based on speculation 
or suspicion.
    4. A ``similar fault'' finding is sufficient to take the 
administrative actions described in this Ruling. Although a finding of 
``fraud'' made as part of a criminal prosecution can serve as a basis 
for the administrative actions described below, such a finding is not 
required.
    5. A ``similar fault'' finding concerning a material fact may 
constitute evidence to be considered in determining whether there is 
reason to believe that ``similar fault'' was involved with respect to 
other evidence provided by the same source, and may justify 
disregarding other evidence from that source. Also, the evidence relied 
on to make a ``similar fault'' finding in one claim may be considered 
in deciding whether there is ``similar fault'' in another claim or in 
deciding whether to give less weight to evidence in another claim.
    6. A ``similar fault'' finding does not constitute complete 
adjudicative action in any claim. A person may still be found entitled 
to, or eligible for, monthly benefits despite the fact that some 
evidence in the case record has been disregarded based on ``similar 
fault.''

Definitions

    1. Similar Fault. As defined in section 205(u) and 1631(e)(7) of 
the Act, ``similar fault'' is involved if: ``(A) an incorrect or 
incomplete statement that is material to the determination is knowingly 
made; or (B) information that is material to the determination is 
knowingly concealed.'' ``Similar fault'' differs from ``fraud'' in that 
fraud (but not similar fault) includes an element of intent to defraud.
    2. Material. Used to describe a statement or information, or an 
omission from a statement or information, that could influence SSA in 
determining entitlement to monthly benefits under title II or 
eligibility for monthly benefits under title XVI of the Act.
    3. Knowingly. Used to describe how a person acts in furnishing 
information that he or she knows is false or incomplete.
    4. Preponderance of evidence. A standard for deciding questions of 
fact and other issues. To apply this standard, the adjudicator weighs 
the evidence to decide which side of an issue is supported by the 
evidence with the greater weight. Preponderance is established by that 
piece or body of evidence that, when fairly considered, produces the 
stronger impression and is more convincing as to its truth when weighed 
against the evidence in opposition. Thus, ``preponderance'' does not 
require that a certain number of pieces of evidence (e.g., five or six) 
must be present. It is possible that just one piece of evidence may be 
so convincing that it outweighs more than one piece of evidence in 
opposition.

Development and Evaluation

    Adjudicators at all levels of the administrative review process are 
responsible for taking all appropriate steps to resolve ``similar 
fault'' issues in accordance with the standards in this Ruling. 
Adjudicators must adhere to existing due process and confidentiality 
requirements during the process of resolving ``similar fault'' issues.
    In making determinations whether there is ``similar fault,'' all 
adjudicators must:
    1. Consider all evidence in the case record before determining 
whether specific evidence may be disregarded.
    2. Apply the preponderance of evidence standard, as defined in this 
Ruling.
    3. Fully document the record with the evidence that was the basis 
for the finding that, based on a preponderance of the evidence, there 
is reason to believe that ``similar fault'' was involved in providing 
the evidence that is being disregarded.

Notice of Determination or Decision

    In determinations or decisions in which a ``similar fault'' finding 
is being made and evidence is being disregarded, the notice of 
determination or decision must:
    1. Explain the applicable provision of the Act that allows the 
adjudicator to disregard particular evidence due to a ``similar fault'' 
finding.
    2. Identify the documents or other evidence that is being 
disregarded.
    3. Provide a discussion of the evidence that supports a finding to 
disregard evidence. The discussion

[[Page 10142]]

must explain that, in accordance with the law, the evidence identified 
cannot be used as evidence in the claim because, after considering all 
the information in the case record, the adjudicator has reason to 
believe that ``similar fault'' was involved in providing the evidence 
and it must be disregarded. Again, a ``similar fault'' finding can be 
made only if there is reason to believe, based on a preponderance of 
the evidence, that the person knew that the evidence provided was false 
or incomplete. A ``similar fault'' finding cannot be based on 
speculation or suspicion.
    4. Provide a determination or decision based on an evaluation of 
the remaining evidence in accordance with other rules and procedures. A 
``similar fault'' finding does not constitute complete adjudicative 
action in any claim. A person may still be found entitled to, or 
eligible for, monthly benefits despite the fact that some evidence in 
the case record has been disregarded based on ``similar fault.'' For 
example, a person may be found to be under a ``disability'' based on 
impairments that are established by evidence that is not disregarded 
because of ``similar fault.''
    5. Include standard appeal language.
EFFECTIVE DATE:  
    This Ruling is effective February 25, 2000.
CROSS-REFERENCES:  
    SSR 96-7p, ``Titles II and XVI: Evaluation of Symptoms in 
Disability Claims: Assessing the Credibility of an Individual's 
Statements,'' SSR 85-23, ``Title XVI: Reopening Supplemental Security 
Income Determinations at Any Time for ``Similar Fault.'' Program 
Operations Manual System, DI 23025.001-DI 23025.095.

[FR Doc. 00-4417 Filed 2-24-00; 8:45 am]
BILLING CODE 4191-02-U