[Federal Register Volume 68, Number 207 (Monday, October 27, 2003)]
[Proposed Rules]
[Pages 61162-61171]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-26951]


=======================================================================
-----------------------------------------------------------------------

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations No. 4 and 16]
RIN 0960-AF21


Reinstatement of Entitlement to Disability Benefits

AGENCY: Social Security Administration.

ACTION: Notice of proposed rulemaking.

-----------------------------------------------------------------------

SUMMARY: The Social Security Administration is proposing rules 
regarding the Reinstatement of Entitlement (Expedited Reinstatement) 
provision in section 112 of the Ticket to Work and Work Incentives 
Improvement Act of 1999. This provision allows former Social Security 
disability and Supplemental Security Income (SSI) disability or 
blindness beneficiaries, whose entitlement or eligibility had been 
terminated due to their work activity, to have their entitlement or 
eligibility reinstated in a timely fashion if they become unable to do 
substantial gainful work due to their medical condition. These rules 
provide beneficiaries an additional incentive to return to work.

DATES: To be sure your comments are considered we must receive them no 
later than December 26, 2003.

ADDRESSES: You may give us your comments by using: our Internet site 
facility (i.e., Social Security Online) at http://www.socialsecurity.gov/regulations/; by e-mail to 
socialsecurity.gov">regulations@socialsecurity.gov; by telefax to (410) 966-2830; or by 
letter to the Commissioner of Social Security, P.O. Box 17703, 
Baltimore, MD 21235-7703. You may also deliver them to the Office of 
Regulations, Social Security Administration, 100 Altmeyer Building, 
6401 Security Boulevard, Baltimore, MD 21235-6401, between 8 a.m. and 
4:30 p.m. on regular business days. Comments are posted on our Internet 
site, Social Security Online at socialsecurity.gov for your review, or 
you may inspect them on regular business days by making arrangements 
with the contact person shown in this preamble.
    Electronic version: The electronic file of this document is 
available on the date of publication in the Federal Register at http://www.access.gpo.gov/su_docs/aces/aces140.html. It is also available on 
the Internet site for SSA (i.e., Social Security Online): 
socialsecurity.gov.

FOR FURTHER INFORMATION CONTACT: John Nelson, Team Leader, Employment 
Policy Team, Office of Employment Support Programs, Social Security 
Administration, 6401 Security Boulevard, Room 107 Altmeyer Building, 
Baltimore, Maryland 21235-6401, (410) 966-5114 or TTY 410-966-5609. For 
information on eligibility or filing for benefits: Call our national 
toll-free number, 1-(800) 772-1213 or TTY 1-(800) 325-0778, or visit 
our Internet Web site, Social Security Online, at http://www.socialsecurity.gov/regulations/.

SUPPLEMENTARY INFORMATION:

Background

    The expedited reinstatement provision, along with other work 
incentives and the Ticket to Work program contained in the Ticket to 
Work and Work Incentives Improvement Act of 1999 (Public Law 106-170) 
is intended to expand your options as a Social Security disability 
beneficiary or a disabled or blind Supplementary Security Income 
recipient. We expect that the expedited reinstatement provision along 
with other provisions in the Ticket to Work and Work Incentives 
Improvement Act of 1999 will remove some of the disincentives that may 
discourage you from either attempting to work or increasing your work 
activity. If more beneficiaries with disabilities engage in self-
supporting work, the net result will be a reduction in the Social 
Security and Supplemental Security Income disability rolls and savings 
to the Social Security Trust Fund and general revenues.

General Goals of the Expedited Reinstatement Provision

    The expedited reinstatement provision is intended to relieve some 
concerns you may have about returning to work. If we terminate your 
entitlement or eligibility for benefits due to your work activity, this 
provision provides you an easier way to have your entitlement or 
eligibility reinstated and to be placed back into payment status. This 
process should ease some concerns you may have about what will happen 
if your attempt to return to work is unsuccessful.

Advice of the Ticket to Work and Work Incentives Advisory Panel

    During the preparation of these proposed rules, we consulted with 
the Ticket to Work and Work Incentives Advisory Panel.

Section 112 of the Ticket to Work and Work Incentives Improvement Act 
of 1999

    Congress indicated that the purpose of section 112 of the Ticket to 
Work and Work Incentives Improvement Act of 1999 (the expedited 
reinstatement provision) was to encourage disability beneficiaries to 
return to work by reassuring them that benefits would be restored in a 
timely fashion should they become unable to continue working and 
continue to meet disability standards set by SSA.
    Section 112 of Public Law 106-170 amended Sec. Sec.  223 and 1631 
of the Social Security Act (the Act). Section 112(a) added subsection 
(i) to Sec.  223 of the Act and re-designated the prior subsection

[[Page 61163]]

(i) as subsection (j). Section 112(b)(1) added paragraph (p) to Sec.  
1631 of the Act. The expedited reinstatement provision provides a 
method for you to have your disability benefits reinstated without 
filing an application if you have had your entitlement to, or 
eligibility for, benefits terminated due to your work activity during 
the previous 5 years, and you can no longer do substantial gainful 
activity.

Effect of the Expedited Reinstatement Provision

    The expedited reinstatement provision provides you another option 
for regaining entitlement to benefits under title II and eligibility 
under title XVI of the Act after we have terminated your entitlement to 
or eligibility for disability benefits due to your work activity. If 
you file a request for expedited reinstatement you can still file a new 
application for benefits under existing initial claim rules.
    Prior to the effective date of this provision, when we terminated 
your entitlement or eligibility due to work activity, you were required 
to file a new application to become entitled to or eligible for 
benefits again. We processed your application under rules that required 
a new disability determination using our initial claim medical 
requirements. You generally were entitled to receive benefits only 
after we processed your entitlement or eligibility determination. If we 
determined that you again qualified for benefits, you became eligible 
for work incentives such as the trial work period, the reentitlement 
period, and special SSI eligibility status under your new period of 
disability.
    The expedited reinstatement provision provides you the option of 
requesting that your prior entitlement to or eligibility for disability 
benefits be reinstated, rather than filing a new application for a new 
period of entitlement or eligibility. Since January 1, 2001, you can 
request to be reinstated to benefits if you stop doing substantial 
gainful activity within 60 months of your prior termination. You must 
have stopped doing substantial gainful activity because of your medical 
condition. Your current impairment must be the same as or related to 
your prior impairment and you must be disabled. To determine if you are 
disabled, we will use our medical improvement review standard (MIRS) 
that we use in our continuing disability review process. The advantage 
of using MIRS is that we will generally find that you are disabled 
unless your impairment has improved so that you are able to work or 
unless an exception under the MIRS process applies.
    When you request reinstatement you can be paid up to 6 months of 
provisional benefits, and may be entitled to Medicare benefits and/or 
Medicaid, while we are deciding whether you qualify for reinstatement. 
Provisional benefits, or payments, are cash benefits that can be paid 
to you on a temporary basis when you were previously a Social Security 
(title II) disability beneficiary or a disabled or blind Supplemental 
Security Income (title XVI) recipient and you are now requesting 
reinstatement. The period during which you can receive provisional 
benefits is your provisional benefit period. This period begins with 
the first month you can receive provisional benefits and can never 
extend beyond six consecutive months. Your provisional benefit period 
will end earlier than the sixth consecutive month if we make our 
determination on your request for reinstatement before that month. Your 
title II provisional benefit period will also end if you attain 
retirement age or if you do substantial gainful work activity.
    You can receive title II provisional benefits beginning with the 
month you file your request for reinstatement. We will base your 
provisional benefit amount, the amount of the monthly cash benefit you 
receive during the provisional benefit period, on the prior benefit 
amount that was actually payable to you under title II. We will 
terminate your title II provisional benefits when your provisional 
benefit period ends, such as if you do substantial gainful activity. 
You can receive title XVI provisional payments beginning with the month 
after you file your request for reinstatement. We will base your title 
XVI provisional benefit amount, the amount of the monthly cash payment 
you receive during the provisional benefit period, on the federal 
Supplemental Security Income benefit that is actually payable to you, 
depending on your income. We will terminate your title XVI provisional 
payments when your provisional benefit period ends.
    We are proposing to amend Sec. Sec.  404.903 and 416.1403 to 
indicate that a determination we make regarding your right to receive 
provisional benefits is not an initial determination and it is, 
therefore, not subject to administrative review under Sec. Sec.  
404.900ff and 416.1400ff.
    If we deny your request for reinstatement, we generally will not 
consider the provisional benefits you received as an overpayment. If 
your reinstatement request is denied, we will treat that request as 
your intent to file an initial application for benefits. If your 
request for reinstatement is approved, we will reinstate your prior 
disability entitlement or eligibility and reestablish your Medicare/
Medicaid entitlement, as appropriate, if you are not already entitled 
to Medicare/Medicaid. We will pay you reinstated benefits under title 
XVI beginning with the month after the month you filed your request. We 
will pay you reinstated benefits for title II beginning no later than 
the month you filed your request. We can pay you title II reinstated 
benefits for any of the 12 months preceding your request for 
reinstatement if you would have met all of the requirements for 
reinstatement if your request for reinstatement had been timely filed 
for the claimed month. We will reduce reinstated benefits payable for a 
month by the amount of any provisional benefits already received for 
that month.
    When we reinstate your entitlement under this provision you are 
then entitled to a 24-month initial reinstatement period. Your 24-month 
initial reinstatement period begins with the month your benefits are 
reinstated and ends with the 24th month that you have a benefit 
payable. For title II purposes, we consider a benefit to be payable in 
a month when you do not do substantial gainful activity and the non-
payment provisions in Sec.  404.401ff do not apply. For title XVI 
purposes, we consider a benefit to be payable in a month when, using 
normal payment calculation procedures in Sec.  416.101ff, we determine 
you are due a monthly payment. After the 24-month initial reinstatement 
period is completed you are eligible for additional work incentives 
under title II (such as a trial work period and a reentitlement 
period), as well as possible future reinstatement through the expedited 
reinstatement provision under title II and title XVI.

Proposed Regulations

    We are proposing to amend our rules to provide the rules for 
expedited reinstatement. These proposed rules add Sec. Sec.  404.1592b 
through 404.1592g to part 404 and Sec. Sec.  416.999 through 416.999e 
to part 416.

Part 404

    Proposed Sec.  404.1592b provides a general overview of expedited 
reinstatement and summarizes the basic requirements for expedited 
reinstatement, as discussed in Sec. Sec.  404.1592c through 404.1592g.
    Proposed Sec.  404.1592c describes the requirements for 
reinstatement to title II

[[Page 61164]]

benefits. Section 223(i)(1) of the Act lists the requirements you must 
meet to be reinstated through the authority of the title II expedited 
reinstatement provision. These proposed rules explain that you must 
have previously been entitled as a disabled insured individual, a 
disabled child, a disabled widow or widower, or a disabled Medicare 
qualified government employee. We must have terminated your prior 
entitlement due to your doing substantial gainful activity. You must 
have become unable to continue doing substantial gainful activity due 
to your medical condition. Your current impairment must be the same as 
or related to the impairment on which we based your prior period of 
disability, and you must currently be disabled. Section 223(i)(3) of 
the Act requires us to use the medical improvement review standard in 
Section 223(f) of the Act when we determine if you are disabled for the 
purposes of this provision. We are proposing that we will not reinstate 
your entitlement under the expedited reinstatement provision if you 
previously requested expedited reinstatement, or we conducted a 
continuing disability review on a title II disability or Medicare 
entitlement, and we determined you were not disabled under the medical 
improvement review standard. We will also not reinstate your 
entitlement under this provision if you previously requested expedited 
reinstatement for a benefit and we determined you did not have a 
current impairment(s) that was the same as or related to the impairment 
that was the basis for your prior entitlement to that benefit. If you 
are reinstated, an auxiliary beneficiary who was previously entitled on 
your record can also be reinstated. The auxiliary beneficiary must 
apply for reinstatement and must meet the current entitlement factors 
for the benefit.
    Proposed Sec.  404.1592d describes what you must do to request 
reinstatement of benefits under the expedited reinstatement provision. 
Your request must be made in writing. Section 223(i)(2)(A) of the Act 
lists what you must include in your request for reinstatement and 
authorizes us to determine the form of the request and the information 
it must contain. You must file your request within the consecutive 60-
month period that begins with the month that your prior entitlement to 
disability benefits terminated due to the performance of substantial 
gainful activity. However, we may extend this time period if we 
determine that you had good cause for failing to file your request 
within the 60-month time period. Your request must state that you are 
disabled, that your current impairment is the same as or related to the 
impairment that was used as the basis for your prior disability 
entitlement, and that you cannot do substantial gainful activity 
because of your medical condition. The request must also include the 
information we need to help us determine whether you meet the non-
medical factors of entitlement and the information we need to make the 
medical determination. Your request for reinstatement must be filed on 
or after January 1, 2001.
    Proposed Sec.  404.1592e describes how we will determine whether 
you are unable to do substantial gainful activity because of your 
medical condition. We are proposing that you must meet one of two 
requirements. The first requirement is that you are unable to continue 
working, or you reduce your work and earnings below the substantial 
gainful activity level, because of your impairment. The second 
requirement is that you were forced to stop work due to the removal of 
special circumstances that had permitted you to work despite your 
impairment. Under our proposed rules if you stop work for reasons 
beyond your control, such as your employer having terminated you due to 
a general downsizing, and there were special circumstances that allowed 
you to work at that job despite your impairment, we will consider you 
to meet this requirement. For the purposes of this section we consider 
special circumstances to be those in which you have special conditions, 
subsidy, or have some other special need that must be met in order for 
you to be able to work despite your impairment, such as the 
availability of special transportation.
    Proposed Sec.  404.1592f provides information on when your title II 
provisional benefits start, how they are computed, when they are paid, 
and when they end. Section 223(i)(7) of the Act lists the requirements 
for us to pay provisional benefits while we are determining whether to 
approve your request for reinstatement. Consistent with the law, the 
proposed rules explain that we can pay you up to 6 months of 
provisional benefits during your provisional benefit period. In 
addition, if you are not already entitled to Medicare, we can 
reestablish your Medicare entitlement during your provisional benefit 
period. Your entitlement to provisional benefits begins with the month 
your reinstatement request is filed. We will base your provisional 
benefit amount on your monthly insurance benefit that was actually 
payable to you at the time we terminated your prior entitlement. We 
will increase your prior benefit amount payable by any intervening cost 
of living increases that would have been applicable to the prior 
benefit amount under section 215(i) of the Act. If you are entitled to 
another title II benefit or another provisional benefit, the maximum 
benefit amount we will pay you when all benefits are combined will be 
the amount of your highest computed benefit. If you request 
reinstatement as a disabled widow or widower or a disabled child we 
will not adjust your provisional benefit or the benefits of other 
beneficiaries entitled at that time on the same record when the total 
benefit amount exceeds the family maximum.
    We will not pay you a provisional benefit for a month if you are 
not entitled to payment for the month under our usual rules, such as if 
you are a prisoner. We also will not pay you provisional benefits for 
any month that is after the earliest of the following months: the month 
we send you notice of our determination on your request for 
reinstatement; the first month you do substantial gainful activity; the 
month before you attain retirement age; or the fifth month following 
the month you filed your request for reinstatement. We will not pay 
provisional benefits when, prior to starting your provisional benefits, 
we determine that you do not meet the requirements for reinstatement, 
such as, since your prior termination because of work activity we have 
determined that you are not disabled under the medical improvement 
review standard, or we determine that you did not file your request for 
reinstatement timely, or your prior entitlement did not terminate 
because of your doing substantial gainful activity. Our determinations 
on provisional benefit amounts, when they are payable, and when they 
terminate, are final and are not subject to formal administrative 
review. We will not recover a previously existing overpayment from your 
provisional payments unless you give us permission to do so. If we 
determine you are not entitled to reinstated benefits, usually we will 
not consider the provisional benefits you received as an overpayment 
unless we determine you knew or should have known that you did not 
qualify for reinstatement and therefore you should not have received 
the provisional benefits.
    Proposed Sec.  404.1592g discusses how we determine your reinstated 
benefits consistent with the requirements regarding paying reinstated 
benefits in section 223(i). The proposed rules explain that if we have 
determined we can reinstate you in the month you filed

[[Page 61165]]

your reinstatement request, we will then consider whether we can pay 
you retroactive reinstated benefits. We will reinstate your benefits 
beginning with the earliest month in the 12-month period immediately 
preceding the month you requested reinstatement in which you would have 
met all of the reinstatement requirements if you had filed your request 
for reinstatement in that month. We will also reinstate your Medicare 
entitlement. Your entitlement to title II disability benefits and 
Medicare, under the expedited reinstatement provision, cannot be 
reinstated for a month prior to January 2001.
    We will determine and pay your reinstated monthly benefits under 
our normal payment provisions of title II of the Act, with some 
exceptions. We will withhold from your reinstated benefits due for a 
month the amount of any provisional payments we already paid for that 
month. If the provisional benefits we paid you for a month exceed the 
amount of reinstated benefits due you for that month, we will consider 
the difference as an overpayment. We will use the same date of onset to 
calculate your new primary insurance amount as a reinstated individual 
that we used in your most recent period of disability. When you are 
reinstated, you are entitled to a 24-month initial reinstatement 
period. Your initial reinstatement period begins with the month your 
reinstated benefits begin and ends when you have had 24 months of 
payable benefits. We propose to consider a month a payable month when 
you do not do substantial gainful activity and the non-payment 
provisions in Sec.  404.401ff do not apply. During the initial 
reinstatement period, in addition to normal non-payment events, a 
benefit is not payable for any month in which you do substantial 
gainful activity. We will not use our unsuccessful work attempt or 
averaging of earnings provisions when we determine if you have done 
substantial gainful activity in a month during your initial 
reinstatement period. After you complete your initial reinstatement 
period, we will consider your future work under the work incentive 
provisions of title II of the Act. Your trial work period begins the 
month after you complete your initial reinstatement period. Your 
reinstated benefits end with the earliest month that precedes the third 
month following the month in which we determine your disability ceases, 
the month we terminate your benefits for another reason, the month you 
reach retirement age, or the month you die.
    We are proposing that determinations we make regarding your title 
II reinstated benefits will be initial determinations subject to 
administrative and judicial review. If we determine you are not 
entitled to reinstated benefits, we will consider your request for 
reinstatement as your intent to file a new initial claim for the 
benefit.

Part 416

    Proposed Sec.  416.999 provides a general overview of expedited 
reinstatement and a summary of the basic requirements for expedited 
reinstatement, as discussed in Sec. Sec.  416.999a through 416.999e.
    Proposed Sec.  416.999a describes the requirements for 
reinstatement to title XVI benefits. Section 1631(p)(1) of the Act 
lists the requirements to be reinstated through the authority of the 
expedited reinstatement provision. The proposed rules explain that you 
must have previously been eligible based on disability or blindness. We 
must have terminated your prior eligibility due to earned income or a 
combination of earned and unearned income. You must have become unable 
to do substantial gainful activity due to your medical condition. Your 
current impairment must be the same as or related to the impairment on 
which we based your prior eligibility. Also, you must currently be 
disabled. Section 1631(p)(3) of the Act requires we use the medical 
improvement review standard in section 1614(a)(4) of the Act when we 
determine if you are disabled for the purposes of this provision. We 
are proposing that we will not reinstate your eligibility under this 
provision if you previously requested expedited reinstatement, or we 
conducted a continuing disability review for title XVI eligibility, and 
we determined you were not disabled under the medical improvement 
review standard. We will also not reinstate your eligibility under this 
provision if you previously requested expedited reinstatement of your 
title XVI eligibility and we determined you did not have a current 
impairment that was the same as or related to the impairment that was 
the basis for your prior eligibility. When you are reinstated, your 
spouse can be reinstated if your spouse was previously eligible, your 
spouse meets the current eligibility factors for title XVI benefits, 
and your spouse requests reinstatement.
    Proposed Sec.  416.999b describes how to request reinstatement of 
benefits under the expedited reinstatement provision. Your request must 
be in writing. Section 1631(p)(2)(A) of the Act lists what you must 
include in your request for reinstatement and authorizes us to 
determine the form of the request and the information it must contain. 
You must file your request within the consecutive 60-month period that 
begins with the month that we terminated your prior eligibility to 
title XVI disability benefits. However, we may extend this time period 
if we determine that you had good cause for failing to file your 
request within the 60-month period. Your request must include your 
statement that you are disabled, that your current impairment is the 
same as or related to the impairment that we used as the basis for your 
prior disability eligibility, that you cannot do substantial gainful 
activity because of your medical condition, and that you meet all of 
the non-medical requirements for eligibility. Your request must also 
include the information we need to determine whether you meet the non-
medical factors of eligibility for the benefit and the information we 
need to make the medical determination. Your request for reinstatement 
must be filed on or after January 1, 2001.
    Proposed Sec.  416.999c describes how we will determine whether you 
are unable to do substantial gainful activity because of your medical 
condition. We are proposing that you must meet one of two requirements. 
The first requirement is that you are unable to continue working, or 
you reduced your work and earnings below the substantial gainful 
activity level, because of your impairment. The second requirement is 
that you were forced to stop work due to the removal of special 
circumstances that had permitted you to work despite your impairment. 
Under our proposed rules if you stop work for reasons beyond your 
control, such as your employer having terminated you due to a general 
downsizing, and there were special circumstances that allowed you to 
work at that job despite your impairment, we will consider you to meet 
this requirement. For the purposes of this section we consider special 
circumstances to be those when you have been provided special 
conditions or subsidy, or have some other special need that must be met 
in order for you to be able to work despite your impairment, such as 
the availability of special transportation.
    Proposed Sec.  416.999d provides information on when your title XVI 
provisional benefits start, how they are computed, when they are paid, 
and when they end. Section 1631(p)(7) of the Act lists the requirements 
for us to pay you provisional benefits while we are determining whether 
to approve your request for reinstatement. Consistent with the law, the 
proposed

[[Page 61166]]

rules explain that we can pay you up to six months of provisional 
benefits during the provisional benefit period. Your provisional 
benefits will begin with the month after you request reinstatement. We 
will base your provisional benefit amount on normal computational 
methods for an individual receiving SSI benefits under title XVI of the 
Act with the same amounts and kind of income. If your spouse also 
requests reinstatement, we can pay provisional payments to your spouse. 
Your spouse must meet SSI eligibility requirements, except those 
relating to the filing of an application, before we can pay provisional 
payments. We will use the same computation method used for you and your 
spouse's provisional benefit that we would use to figure an eligible 
individual and eligible spouse receiving non-provisional benefits under 
title XVI of the Act with the same kind and amount of income. As 
required by section 1631(p)(8) of the Act, you are not eligible for 
state supplementary payments during the provisional benefit period.
    We will not pay provisional benefits for any month where a 
suspension or terminating event occurs under our usual rules, such as 
when you are in an institution or if you die. We also will not pay 
provisional benefits for any month after the earliest month either of 
the following events occur: the month we send you our notice of our 
determination on your request for reinstatement or the sixth month 
following the month you filed your request for reinstatement. We will 
not pay provisional benefits when, prior to starting your provisional 
benefits, we determine you do not meet the requirements for 
reinstatement, such as, since your prior termination due to your earned 
income we have determined that you are not disabled under the medical 
improvement review standard, or we determine that you did not file your 
request for reinstatement timely, or we determine that your prior 
eligibility terminated for a reason unrelated to income. Our 
determinations on your provisional benefit amounts, when they are 
payable, and when they terminate, are final and are not subject to 
formal administrative review. We will not recover previously existing 
overpayments from your provisional payments unless you give us 
permission to do so. If we determine that you are not eligible for 
reinstated benefits, usually we will not consider the provisional 
payments you received as an overpayment unless you knew or should have 
known that you did not qualify for reinstatement and you should not 
have received provisional payments.
    Proposed Sec.  416.999e discusses how we determine your reinstated 
SSI benefits consistent with the requirements in section 1631(p)(4). 
The proposed rules explain that we will reinstate your eligibility, and 
your spouse's eligibility, with the month following the month you filed 
your request for reinstatement. Your eligibility cannot be reinstated 
for a month prior to February 2001.
    We will determine and pay your reinstated benefits under the normal 
payment provisions of title XVI of the Act, with one exception. We will 
withhold from your reinstated benefits due in a month the amount of any 
provisional payments you were already paid for that month. If we pay 
you a provisional benefit for a month that exceeds the amount of your 
reinstated benefit due, we will consider the difference an overpayment. 
When your request for reinstatement is approved, you are eligible for a 
24-month initial reinstatement period. Your initial reinstatement 
period begins with the month your reinstated benefits begin and ends 
when you have had 24 months of payable benefits. We propose to consider 
a month a payable month when, considering the normal payment rules, you 
are due a benefit payment for the month. After you complete the initial 
reinstatement period, you are again eligible for expedited 
reinstatement if we terminate your eligibility due to income. Your 
reinstated benefits end with the earliest month that precedes the third 
month following the month in which we determine your disability ceases, 
the month before we terminate your eligibility for another reason, or 
the month you die.
    We are proposing that we will consider determinations we make 
regarding your title XVI reinstated benefits to be initial 
determinations subject to administrative and judicial review. If we 
determine you are not eligible for reinstated benefits we will consider 
your request for reinstatement your intent to file a new initial claim 
for benefits.

Regulatory Procedures

Clarity of These Proposed Rules

    Executive Order 12866 requires each agency to write all rules in 
plain language. In addition to your substantive comments on these 
proposed rules, we invite your comments on how to make these proposed 
rules easier to understand. For example:
    [sbull] Have we organized the material to suit your needs?
    [sbull] Are the requirements in the rules clearly stated?
    [sbull] Do the rules contain technical language or jargon that 
isn't clear?
    [sbull] Would a different format (grouping and order of sections, 
use of headings, paragraphing) make the rules easier to understand?
    [sbull] Would more (but shorter) sections be better?
    [sbull] Could we improve clarity by adding tables, lists, or 
diagrams?
    [sbull] What else could we do to make the rules easier to 
understand?

Executive Order 12866

    We have consulted with the Office of Management and Budget (OMB) 
and determined that these proposed rules meet the criteria for a 
significant regulatory action under Executive Order 12866, as amended 
by Executive Order 13258. Thus, they were subject to OMB review.

Regulatory Flexibility Act

    We certify that these proposed rules would not have a significant 
economic impact on a substantial number of small entities because they 
would primarily affect only individuals. Thus an initial regulatory 
flexibility analysis as provided in the Regulatory Flexibility Act, as 
amended, is not required.

Paperwork Reduction Act

    These proposed rules contain reporting requirements as shown in the 
following table.

----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                                        Annual  number                              burden per       Estimated
                Section                  of  responses    Frequency of response      response      total burden
                                                                                      (Mins.)         (Hrs.)
----------------------------------------------------------------------------------------------------------------
404.1592c & 404.1592d.................          10,000  One time................              85          14,167
416.999a & 416.999b...................             100  One time................              79             132
=======================================

[[Page 61167]]

=======================================
----------------------------------------------------------------------------------------------------------------

    An Information Collection Request has been submitted to OMB for 
clearance. We are soliciting comments on the burden estimate; the need 
for the information; its practical utility; ways to enhance its 
quality, utility and clarity; and on ways to minimize the burden on 
respondents, including the use of automated collection techniques or 
other forms of information technology. Comments should be submitted to 
the Office of Management and Budget and to the Social Security 
Administration at the following addresses/fax numbers: Office of 
Management and Budget, Attn: Desk Officer for SSA, Room 10235, New 
Executive Office Bldg., 725 17th St., NW., Washington, DC 20503, Fax 
No. 202-395-6974. Social Security Administration, Attn: SSA Reports 
Clearance Officer, 1338 Annex Building, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, Fax No. 410-965-6400.
    Comments can be received between 30 and 60 days after publication 
of this notice and will be most useful if received by SSA within 30 
days of publication. To receive a copy of the OMB clearance package, 
you may call the SSA Reports Clearance Officer on 410-965-0454.

(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social 
Security--Disability Insurance; 96.002, Social Security--Retirement 
Insurance; 96.004, Social Security--Survivors Insurance; 96.006, 
Supplemental Security Income.)

List of Subjects

20 CFR Part 404

    Administrative practice and procedure, Blind, Disability benefits, 
Old-age, Survivors, and Disability Insurance, Reporting and 
recordkeeping requirements, Social Security.

20 CFR Part 416

    Administrative practice and procedure, Aged, Blind, Disability 
benefits, Public assistance programs, Reporting and recordkeeping 
requirements, Supplemental Security Income (SSI).

    Dated: July 22, 2003.
Jo Anne B. Barnhart,
Commissioner of Social Security.

    For the reasons set forth in the preamble, we propose to amend part 
404, subparts J and P, and part 416, subparts I and N of title 20 of 
the Code of Federal Regulations to read as follows:

PART 404--FEDERAL OLD-AGE, SURVIVOR AND DISABILITY INSURANCE (1950-
)

Subpart J--[Amended]

    1. The authority citation for subpart J is revised to read as 
follows:

    Authority: Secs. 201(j), 204(f), 205(a), (b), (d)-(h), and (j), 
221, 223(i), 225, and 702(a)(5) of the Social Security Act (42 
U.S.C. 401(j), 404(f), 405(a), (b), (d)-(h), and (j), 421, 423 (i), 
425, and 902(a)(5)); 31 U.S.C. 3720A; sec. 5 Pub. L. 97-455, 96 
Stat. 2500 (42 U.S.C. 405 note); secs. 5, 6(c)-(e), and 15, Pub. L. 
98-460, 98 Stat. 1802 (42 U.S.C. 421 note).

    2. Amend Sec.  404.903 to revise paragraphs (t) and (u) and add 
paragraph (v) to read as follows:


Sec.  404.903  Administrative actions that are not initial 
determinations.

* * * * *
    (t) Determining whether we will refer information about your 
overpayment to a consumer reporting agency (see Sec.  404.527 and Sec.  
422.305 of this chapter);
    (u) Determining whether we will refer your overpayment to the 
Department of the Treasury for collection by offset against Federal 
payments due you ( see Sec. Sec.  404.527 and 422.310 of this chapter); 
and
    (v) Determining whether provisional benefits are payable, the 
amount of the provisional benefits, and when provisional benefits 
terminate (see Sec.  404.1592f).

Subpart P--[Amended]

    3. The authority citation for subpart P continues to read as 
follows:

    Authority: Secs. 202, 205(a), (b), and (d)-(h), 216(i), 221(a) 
and (i), 222(c), 223, 225, and 702(a)(5) of the Social Security Act 
(42 U.S.C. 402, 405(a), (b), and (d)-(h), 416(i), 421(a) and (i), 
422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193, 110 
Stat. 2105, 2189.

    4. Add new Sec. Sec.  404.1592b through 404.1592g to read as 
follows:


Sec.  404.1592b  What is expedited reinstatement?

    The expedited reinstatement provision provides you another option 
for regaining entitlement to benefits when we previously terminated 
your entitlement to disability benefits due to your work activity. The 
expedited reinstatement provision provides you the option of requesting 
that your prior entitlement to disability benefits be reinstated, 
rather than filing a new application for a new period of entitlement. 
Since January 1, 2001, you can request to be reinstated to benefits if 
you stop doing substantial gainful activity within 60 months of your 
prior termination. You must have stopped doing substantial gainful 
activity because of your medical condition. Your current impairment 
must be the same as or related to your prior impairment and you must be 
disabled. To determine if you are disabled, we will use our medical 
improvement review standard (MIRS) that we use in our continuing 
disability review process. The advantage of using MIRS is that we will 
generally find that you are disabled unless your impairment has 
improved so that you are able to work or unless an exception under the 
MIRS process applies. We explain the rules for expedited reinstatement 
in Sec. Sec.  404.1592c through 404.1592g.


Sec.  404.1592c  Who is entitled to expedited reinstatement?

    (a) You can have your entitlement to benefits reinstated under 
expedited reinstatement if--
    (1) You were previously entitled to a disability benefit on your 
own record of earnings as indicated in Sec.  404.315, or as a disabled 
widow or widower as indicated in Sec.  404.335, or as a disabled child 
as indicated in Sec.  404.350, or to Medicare entitlement based on 
disability and Medicare qualified government employment as indicated in 
42 CFR 406.15;
    (2) Your disability entitlement referred to in paragraph (a)(1) of 
this section was terminated because you did substantial gainful 
activity;
    (3) You file your request for reinstatement timely under Sec.  
404.1592d; and
    (4) In the month you file your request for reinstatement--
    (i) You are not able to do substantial gainful activity because of 
your medical condition;
    (ii) Your current impairment is the same as or related to the 
impairment that we used as the basis for your previous entitlement 
referred to in paragraph (a)(2) of this section; and

[[Page 61168]]

    (iii) You are disabled, as determined under the medical improvement 
review standard in Sec. Sec.  404.1594(a) through 404.1594(f).
    (b) You can not be reinstated under paragraph (a) of this section 
if--
    (1) You previously filed a request for expedited reinstatement and 
we denied that request because we determined that you were not disabled 
under the medical improvement review standard or that you did not have 
a current impairment(s) that was the same as or related to the 
impairment(s) that we used as the basis for your prior entitlement to 
that benefit; or
    (2) We previously determined you were no longer disabled based upon 
the medical improvement review standard in Sec.  404.1594 because--
    (i) We conducted a continuing disability review on a disability 
entitlement, such as a disability benefit, a disabled child benefit, a 
disabled widow(er) benefit, or Medicare entitlement based on Medicare 
qualified government employment, or
    (ii) We conducted a medical review on your Medicare entitlement 
that had previously been continued under 42 CFR 406.12(e).
    (c) You are entitled to reinstatement on the record of an insured 
person who is or has been reinstated if--
    (1) You were previously entitled to one of the following benefits 
on the record of the insured person--
    (i) A spouse or divorced spouse benefit under Sec. Sec.  404.330 
and 404.331;
    (ii) A child's benefit under Sec.  404.350; or
    (iii) A parent's benefit under Sec.  404.370;
    (2) You were entitled to benefits on the record when we terminated 
the insured person's entitlement;
    (3) You meet the requirements for entitlement to the benefit 
described in the applicable paragraph (c)(1)(i) through (c)(1)(iii) of 
this section; and
    (4) You request to be reinstated.


Sec.  404.1592d  How do I request reinstatement?

    (a) You must make your request for reinstatement in writing;
    (b) You must have filed your request on or after January 1, 2001; 
and
    (c) You must provide the information we request so that we can 
determine whether you meet the requirements for reinstatement as 
indicated in Sec.  404.1592c.
    (d) If you request reinstatement under Sec.  404.1592c(a)--
    (1) We must receive your request within the consecutive 60-month 
period that begins with the month in which your entitlement terminated 
due to doing substantial gainful activity. If we receive your request 
after the 60-month period we can grant you an extension if we determine 
you had good cause under the standards explained in Sec.  404.911 for 
not filing the request timely; and
    (2) You must certify that you are disabled, that your current 
impairment(s) is the same as or related to the impairment(s) that we 
used as the basis for the benefit you are requesting to be reinstated, 
and that you became unable to continue to do substantial gainful 
activity because of your medical condition.


Sec.  404.1592e  How do we determine whether you are unable to do 
substantial gainful activity because of your medical condition?

    (a) You are unable to do substantial gainful activity because of 
your medical condition when you become unable to continue working, or 
you reduce your work and earnings below the substantial gainful 
activity earnings level, due to your impairment or because special 
circumstances that permitted you to work despite your impairment are 
removed. We will consider special circumstances that permitted you to 
work despite your impairment to have been removed, for instance, when 
your employer terminates you during a general layoff from a job that 
you performed under special circumstances or you must stop that work 
due to a natural disaster.
    (b) We will not consider you unable to do substantial gainful 
activity because of your medical condition when you stop work, or 
reduce your work and earnings below the substantial gainful level, for 
reasons unrelated to your medical condition. We will not consider you 
unable to do substantial gainful activity because of your medical 
condition when, for instance, you are not working because you work in 
seasonal employment and you are now in the normal off-season or you 
stop work for personal reasons not related to your medical condition.
    (c) Examples:

    Example 1. Mr. K is laid-off from his job because the business 
owners close the plant where he is working. Mr. K was able to work 
at this plant because it was located close to the bus line located 
near his house. Mr. K must work near a bus line because of his 
medical condition. Mr. K is considered to have stopped work due to 
his medical condition under paragraph (a) of this section. Mr. K had 
special transportation accommodations that allowed him to work in 
that job as indicated in paragraph (d) of this section.
    Example 2. Mr. L is laid-off from his job because the owners are 
retooling the plant where he is working. Mr. L had no special 
circumstances under paragraph (d) of this section that enabled him 
to work. Under paragraph (b) of this section, Mr. L is not 
considered to have stopped work due to his medical condition because 
he stopped work for reasons unrelated to his medical condition and 
he had no special circumstances related to his employment.
    Example 3. Ms. M works as a teacher. Her contract requires her 
to work from September of one year through June of the next year. 
Ms. M contacts us in July and indicates she last worked in June. She 
indicates she is in her normal off-work period and plans to return 
to work in September when her next contract begins. She indicates 
the reason she stopped work is her contract is over. She has nothing 
else preventing her from working in July. Under paragraph (b) of 
this section, Ms. M is not considered to have stopped work because 
of her medical condition.

    (d) When we consider whether you had special circumstances in your 
work for purposes of this section, we will consider how well you did 
your work as discussed in Sec.  404.1573(b), whether your work was done 
under special conditions as discussed in Sec.  404.1573(c), and whether 
you were able to work because you had a special need that was being 
accommodated, such as special transportation requirements.


Sec.  404.1592f  How do we determine provisional benefits?

    (a) You may receive up to 6 consecutive months of provisional cash 
benefits and Medicare during the provisional benefit period, while we 
determine whether we can reinstate your disability benefit entitlement 
under Sec.  404.1592c--
    (1) We will pay you provisional benefits, and reinstate your 
Medicare if you are not already entitled to Medicare, beginning with 
the month you file your request for reinstatement under Sec.  
404.1592c(a);
    (2) We will pay you a monthly provisional benefit amount equal to 
the last monthly benefit payable to you during your prior entitlement, 
increased by any cost of living increases that would have been 
applicable to the prior benefit amount under Sec.  404.270. The last 
monthly benefit payable is the amount of the monthly insurance benefit 
we determined that was actually paid to you for the month before the 
month in which your entitlement was terminated, after we applied the 
reduction, deduction and nonpayment provisions in Sec.  404.401 through 
Sec.  404.480;
    (3) If you are entitled to another monthly benefit payable under 
the provisions of title II of the Act for the same month you can be 
paid a provisional benefit, we will pay you an amount equal to the 
higher of the benefits payable;

[[Page 61169]]

    (4) If you request reinstatement for more than one benefit 
entitlement, we will pay you an amount equal to the higher of the 
provisional benefits payable;
    (5) If you are eligible for Supplementary Security Income payments 
under Sec. Sec.  416.200 through 416.269 of this chapter, including 
provisional payments, we will reduce your provisional benefits under 
Sec.  404.408b if applicable; and
    (6) We will not reduce your provisional benefit, or the payable 
benefit to other individuals entitled on an earnings record, under 
Sec.  404.403, when your provisional benefit causes the total benefits 
payable on the earnings record to exceed the family maximum.
    (b) We will not pay you a provisional benefit for a month when an 
applicable nonpayment rule applies. Examples of when we will not pay a 
benefit include, but are not limited to--
    (1) If you are a prisoner under Sec.  404.468;
    (2) If you have been removed/deported under Sec.  404.464; or
    (3) If you are an alien outside the United States under Sec.  
404.460.
    (c) We will not pay you a provisional benefit for any month that is 
after the earliest of the following months--
    (1) The month we send you a notice of our determination on your 
request for reinstatement;
    (2) The month you do substantial gainful activity;
    (3) The month before the month you attain full retirement age; or
    (4) The fifth month following the month you requested expedited 
reinstatement.
    (d) You are not entitled to provisional benefits if, prior to 
starting your provisional benefits--
    (1) We determine that you do not meet the requirements for 
reinstatement under Sec. Sec.  404.1592c(a)(1) through 404.1592c(a)(3);
    (2) We determine that you are not entitled to reinstatement under 
Sec.  404.1592c(b); or
    (3) We determine that your statements on your request for 
reinstatement, made under Sec.  404.1592d(d)(2), are false.
    (e) Determinations we make regarding your provisional benefits 
under paragraphs (a) through (d) of this section are final and are not 
subject to administrative and judicial review under Sec. Sec.  404.900 
through 404.999d.
    (f) If you were previously overpaid benefits under title II or 
title XVI of the Act, we will not recover the overpayment from your 
provisional benefits unless you give us permission. We can recover 
Medicare premiums you owe from your provisional benefits.
    (g) If we determine you are not entitled to reinstated benefits, 
provisional benefits we have already paid you under this section that 
were made prior to the termination month under paragraph (c) of this 
section, will not be subject to recovery as an overpayment unless we 
determine that you knew, or should have known, you did not meet the 
requirements for reinstatement in Sec.  404.1592c.


Sec.  404.1592g  How do we determine reinstated benefits?

    (a) If you meet the requirements for reinstatement under Sec.  
404.1592c(a), we will then consider in which month to reinstate your 
entitlement. We will reinstate your entitlement with the earliest 
month, in the 12-month period that ends with the month before you filed 
your request for reinstatement, that you would have met all of the 
requirements under Sec.  404.1592c(a) if you had filed your request for 
reinstatement in that month. Otherwise, you will be entitled to 
reinstated benefits beginning with the month in which you filed your 
request for such benefits. We cannot reinstate your entitlement for any 
month prior to January 2001.
    (b) When your entitlement is reinstated, you are also entitled to 
Medicare benefits under the provisions of 42 CFR part 406.
    (c) We will compute your reinstated benefit amount and determine 
benefits payable under the applicable paragraphs of Sec. Sec.  404.201 
through 404.480 with certain exceptions--
    (1) We will reduce your reinstated benefit due in a month by a 
provisional benefit we already paid you for that month. If your 
provisional benefit paid for a month exceeds the reinstated benefit, we 
will treat the difference as an overpayment under Sec. Sec.  404.501 
through 404.527.
    (2) If you are reinstated on your own earnings record, we will 
compute your primary insurance amount with the same date of onset we 
used in your most recent period of disability on your earnings record.
    (d) We will not pay you reinstated benefits for any months of 
substantial gainful activity during your initial reinstatement period. 
During the initial reinstatement period the trial work period 
provisions of Sec.  404.1592 and the reentitlement period provisions of 
Sec.  404.1592a do not apply. The initial reinstatement period begins 
with the month your reinstated benefits begin under paragraph (a) of 
this section and ends when you have had 24 payable months of reinstated 
benefits. We consider you to have a payable month for the purposes of 
this paragraph when you do not do substantial gainful activity in that 
month and the non-payment provisions in Sec.  404.401 through 404.480 
also do not apply. When we determine if you have done substantial 
gainful activity in a month during the initial reinstatement period, we 
will consider only your work in, or earnings for, that month. We will 
not apply the unsuccessful work attempt provisions of Sec. Sec.  
404.1574(c) and 404.1575(d) or the averaging of earnings provisions in 
Sec.  404.1574a.
    (e) After you complete the 24-month initial reinstatement period as 
indicated in paragraph (d) of this section, your subsequent work will 
be evaluated under the trial work provisions in Sec.  404.1592 and then 
the reentitlement period in Sec.  404.1592a.
    (f) Your entitlement to reinstated benefits ends with the month 
before the earliest of the following months--
    (1) The month an applicable terminating event in Sec.  404.301 
through 404.392 occurs;
    (2) The month in which you reach retirement age;
    (3) The third month following the month in which your disability 
ceases; or
    (4) The month in which you die.
    (g) Determinations we make under Sec. Sec.  404.1592g are initial 
determinations under Sec.  404.902 and subject to review under 
Sec. Sec.  404.900 through 404.999d.
    (h) If we determine you are not entitled to reinstated benefits we 
will consider your request filed under Sec.  404.1592c(a) your intent 
to claim benefits under Sec.  404.630.

PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND 
DISABLED

Subpart I--[Amended]

    5. The authority citation for subpart I of part 416 is revised to 
read as follows:

    Authority: Secs. 702(a)(5), 1611, 1614, 1619, 1631(a), (c), 
(d)(1), and (p) and 1633 of the Social Security Act (42 U.S.C. 
902(a)(5), 1382, 1382c, 1382h, 1383(a), (c), (d)(1), and (p), and 
1383b); secs. 4(c) and 5, 6(c)-(e), 14(a), and 15, Pub. L. 98-460, 
98 Stat. 1794, 1801, 1802, and 1808 (42 U.S.C. 421 note, 423 note, 
and 1382h note).

    6. Add new Sec. Sec.  416.999 through 416.999e to read as follows:


Sec.  416.999  What is expedited reinstatement?

    The expedited reinstatement provision provides you another option 
for regaining eligibility for benefits when we previously terminated 
your eligibility to disability benefits due to your work activity. The 
expedited

[[Page 61170]]

reinstatement provision provides you the option of requesting that your 
prior eligibility for disability benefits be reinstated, rather than 
filing a new application for a new period of eligibility. Since January 
1, 2001, you can request to be reinstated to benefits if you stop doing 
substantial gainful activity within 60 months of your prior 
termination. You must have stopped doing substantial gainful activity 
because of your medical condition. Your current impairment must be the 
same as or related to your prior impairment and you must be disabled. 
To determine if you are disabled, we will use our medical improvement 
review standard (MIRS) that we use in our continuing disability review 
process. The advantage of using MIRS is that we will generally find 
that you are disabled unless your impairment has improved so that you 
are able to work or unless an exception under the MIRS process applies. 
We explain the rules for expedited reinstatement in Sec. Sec.  416.999a 
through 416.999e.


Sec.  416.999a  Who is eligible for expedited reinstatement?

    (a) You can have your eligibility to benefits reinstated under 
expedited reinstatement if--
    (1) You were previously eligible for a benefit based on disability 
or blindness as explained in Sec.  416.202;
    (2) Your disability or blindness eligibility referred to in 
paragraph (a)(1) of this section was terminated because of earned 
income or a combination of earned and unearned income;
    (3) You file your request for reinstatement timely under Sec.  
416.999b; and
    (4) In the month you file your request for reinstatement--
    (i) You are not able to do substantial gainful activity because of 
your medical condition,
    (ii) Your current impairment is the same as or related to the 
impairment that we used as the basis for your previous eligibility 
referred to in paragraph (a)(2) of this section,
    (iii) You are disabled or blind, as determined under the medical 
improvement review standard in Sec. Sec.  416.994 or 416.994a, and
    (iv) You meet the non-medical requirements for eligibility as 
explained in Sec.  416.202.
    (b) You cannot be reinstated under paragraph (a) of this section 
if--
    (1) You previously filed a request for expedited reinstatement and 
we denied that request because we determined that you were not disabled 
under the medical improvement review standard or that you did not have 
a current impairment(s) that was the same as or related to the 
impairment(s) that we used as the basis for your prior entitlement to 
that benefit; or
    (2) We previously determined you were not disabled or blind based 
upon the medical improvement review standard in Sec. Sec.  416.994 or 
416.994a.
    (c) You are eligible for reinstatement if you are the spouse of an 
individual who can be reinstated under Sec.  416.999a if--
    (1) You were previously an eligible spouse of the individual;
    (2) You meet the requirements for eligibility as explained in Sec.  
416.202 except the requirement that you must file an application; and
    (3) You request reinstatement.


Sec.  416.999b  How do I request reinstatement?

    (a) You must make your request for reinstatement in writing;
    (b) You must have filed your request on or after January 1, 2001;
    (c) You must provide the information we request so that we can 
determine whether you meet the eligibility requirements listed in Sec.  
416.999a;
    (d) We must receive your request within the consecutive 60-month 
period that begins with the month in which your eligibility terminated 
due to earned income, or a combination of earned and unearned income. 
If we receive your request after the 60-month period, we can grant you 
an extension if we determine you had good cause, under the standards 
explained in Sec.  416.1411, for not filing the request timely; and
    (e) You must certify that you are disabled, that your current 
impairment(s) is the same as or related to the impairment(s) that we 
used as the basis for the eligibility you are requesting to be 
reinstated, that you became unable to continue to do substantial 
gainful activity because of your medical condition, and that you meet 
the non-medical requirements for eligibility for benefits.


Sec.  416.999c  How do we determine whether you are unable to do 
substantial gainful activity because of your medical condition?

    (a) You are unable to do substantial gainful activity because of 
your medical condition when you become unable to continue working, or 
you reduce your work and earnings below the substantial gainful 
activity earnings level, due to your impairment or because special 
circumstances that permitted you to work despite your impairment are 
removed. We will consider special circumstances that permitted you to 
work despite your impairment to have been removed, for instance, when 
your employer terminates you during a general layoff from a job that 
you performed under special circumstances or you must stop that work 
due to a natural disaster.
    (b) We will not consider you unable to do substantial gainful 
activity because of your medical condition when you stop work, or 
reduce your work and earnings below the substantial gainful level, for 
reasons unrelated to your medical condition. We will not consider you 
unable to do substantial gainful activity because of your medical 
condition when, for instance, you are not working because you work in 
seasonal employment and you are now in the normal off-season or you 
stop work for personal reasons not related to your medical condition.
    (c) Examples:

    Example 1. Mr. K is laid-off from his job because the business 
owners close the plant where he is working. Mr. K was able to work 
at this plant because it was located close to the bus line located 
near his house. Mr. K must work near a bus line because of his 
medical condition. Mr. K is considered to have stopped work due to 
his medical condition under paragraph (a) of this section. Mr. K had 
special transportation accommodations that allowed him to work in 
that job as indicated in paragraph (d) of this section.
    Example 2. Mr. L is laid-off from his job because the owners are 
retooling the plant where he is working. Mr. L had no special 
circumstances under paragraph (d) of this section that enabled him 
to work. Under paragraphs (a) and (b) of this section, Mr. L is not 
considered to have stopped work due to his medical condition because 
he stopped work for reasons unrelated to his medical condition and 
he had no special circumstances related to his employment.
    Example 3. Ms. M works as a teacher. Her contract requires her 
to work from September of one year through June of the next year. 
Ms. M contacts us in July and indicates she last worked in June. She 
indicates she is in her normal off-work period and plans to return 
to work in September when her next contract begins. She indicates 
the reason she stopped work is her contract is over. She has nothing 
else preventing her from working in July. Under paragraph (b) of 
this section, Ms. M is not considered to have stopped work because 
of her medical condition.
    (d) When we consider whether you had special circumstances in 
your work for purposes of this section, we will consider how well 
you did your work as discussed in Sec.  416.973(b), whether your 
work was done under special conditions as discussed in Sec.  
416.973(c), and whether you were able to work because you had a 
special need that was being accommodated, such as special 
transportation requirements.


Sec.  416.999d  How do we determine provisional benefits?

    (a) You may receive up to 6 consecutive months of provisional cash

[[Page 61171]]

benefits and Medicaid during the provisional benefit period, while we 
determine whether we can reinstate your disability benefit eligibility 
under Sec.  416.999a--
    (1) We will pay you provisional benefits beginning with the month 
after you file your request for reinstatement under Sec.  416.999a(a);
    (2) If you are an eligible spouse, you can receive provisional 
benefits with the month your spouse's provisional benefits begin;
    (3) We will pay you a monthly provisional benefit amount equal to 
the monthly amount that would be payable to an eligible individual 
under Sec. Sec.  416.401 through 416.435 with the same kind and amount 
of income as you have;
    (4) If you have an eligible spouse, we will pay you and your spouse 
a monthly provisional benefit amount equal to the monthly amount that 
would be payable to an eligible individual and eligible spouse under 
Sec.  416.401 through 416.435 with the same kind and amount of income 
as you and your spouse have; and
    (5) Your provisional benefits will not include state supplementary 
payments payable under Sec. Sec.  416.2001 through 416.2176.
    (b) We will not pay you a provisional benefit for a month where you 
are not eligible for a payment under Sec. Sec.  416.1322, 416.1323, 
416.1325, 416.1327, 416.1329, 416.1330, 416.1334, and 416.1339.
    (c) We will not pay you a provisional benefit for any month that is 
after the earliest of: The month we send you notice of our 
determination on your request for reinstatement; or, the sixth month 
following the month you requested expedited reinstatement.
    (d) You are not eligible for provisional benefits if, prior to 
starting your provisional benefits--
    (1) We determine that you do not meet the requirements for 
reinstatement under Sec. Sec.  416.999a(a)(1) through 416.999a(a)(3);
    (2) We determine that you are not eligible for reinstatement under 
Sec.  416.999a(b); or
    (3) We determine that your statements on your request for 
reinstatement, made under Sec.  416.999b(d)(2), are false.
    (e) Determinations we make regarding your provisional benefits 
under paragraphs (a) through (d) of this section are final and are not 
subject to administrative and judicial review under Sec. Sec.  416.1400 
through 416.1499.
    (f) If you were previously overpaid benefits under title II or 
title XVI of the Act, we will not recover the overpayment from your 
provisional benefits unless you give us permission.
    (g) If we determine you are not eligible to receive reinstated 
benefits, provisional benefits we have already paid you under this 
section that were made prior to the termination month under paragraph 
(c) of this section, will not be subject to recovery as an overpayment 
unless we determine that you knew, or should have known, you did not 
meet the requirements for reinstatement in Sec.  416.999a.


Sec.  416.999e  How do we determine reinstated benefits?

    (a) If you meet the requirements for reinstatement under Sec.  
416.999a(a), we will reinstate your benefits with the month after the 
month you filed your request for reinstatement. We cannot reinstate 
your eligibility for any month prior to February 2001.
    (b) We will compute your reinstated benefit amount and determine 
benefits payable under the applicable paragraphs in Sec. Sec.  416.401 
through 416.435. We will reduce your reinstated benefit due in a month 
by a provisional benefit we already paid you for that month. If your 
provisional benefit paid for a month exceeds the reinstated benefit 
due, we will treat the difference as an overpayment under Sec.  
416.536.
    (c) Once you have been reinstated under Sec.  416.999a you cannot 
be reinstated again until you have completed a 24-month initial 
reinstatement period. Your initial reinstatement period begins with the 
month your reinstated benefits begin under paragraph (a) of this 
section and ends when you have had 24 payable months of reinstated 
benefits. We consider you to have a payable month for the purposes of 
this paragraph when you are due a cash benefit of any amount for the 
month based upon our normal computation and payment rules in Sec.  
416.401 through Sec.  416.435. If your entire benefit payment due you 
for a month is adjusted for recovery of an overpayment under Sec.  
416.570 and Sec.  416.571 or if the amount of the provisional benefit 
already paid you for a month exceeds the amount of the reinstated 
benefit payable for that month so that no additional payment is due, we 
will consider the month a payable month.
    (d) Your eligibility to reinstated benefits ends with the month 
preceding the earliest of the following months--
    (1) The month an applicable terminating event in Sec. Sec.  
416.1331 through 416.1339 occurs;
    (2) The third month following the month in which your disability 
ceases; or
    (3) The month in which you die.
    (e) Determinations we make under this section are initial 
determinations under Sec.  416.1402 and are subject to review under 
Sec.  416.1400 through 416.1499.
    (f) If we determine you are not eligible for reinstated benefits, 
we will consider your request filed under Sec.  416.999a(a) your intent 
to claim benefits under Sec.  416.340.

Subpart N--[Amended]

    7. The authority citation for subpart N continues to read as 
follows:

    Authority: Secs. 702(a)(5), 1631, and 1633 of the Social 
Security Act (42 U.S.C. 902(a)(5), 1383, and 1383b); 31 U.S.C. 
3720A.

    8. Amend Sec.  416.1403 by revising paragraphs (a) (18) and (19), 
adding paragraph (a) (20), and revising paragraphs (b)(1) and (2) to 
read as follows:


Sec.  416.1403  Administrative actions that are not initial 
determinations.

    (a) * * *
    (18) Determining whether we will refer information about your 
overpayment to a consumer reporting agency (see Sec. Sec.  416.590 and 
422.305 of this chapter);
    (19) Determining whether we will refer your overpayment to the 
Department of the Treasury for collection by offset against Federal 
payments due you (see Sec. Sec.  416.590 and 422.310 of this chapter); 
and
    (20) Determining when provisional benefits are payable, the amount 
of the provisional benefit payable, and when provisional benefits 
terminate. (See Sec.  416.999d).
    (b) * * *
    (1) If you receive an emergency advance payment; presumptive 
disability or presumptive blindness payment, or provisional payment, we 
will provide a notice explaining the nature and conditions of the 
payments.
    (2) If you receive presumptive disability or presumptive blindness 
payments, or provisional payments, we shall send you a notice when 
those payments are exhausted.
* * * * *
[FR Doc. 03-26951 Filed 10-24-03; 8:45 am]
BILLING CODE 4191-02-P