[Federal Register Volume 75, Number 140 (Thursday, July 22, 2010)]
[Proposed Rules]
[Pages 42639-42643]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-17896]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Docket No. SSA-2007-0092]
RIN 0960-AG72


Amendments to Procedures for Certain Determinations and Decisions

AGENCY: Social Security Administration.

ACTION: Notice of proposed rulemaking.

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SUMMARY: We propose to revise the procedures for how claimants who 
request hearings before administrative law judges (ALJs) may seek 
further review of their fully favorable revised determinations based on 
prehearing case reviews or fully favorable attorney advisor decisions. 
We also propose to notify claimants who receive partially favorable 
determinations based on prehearing case reviews that an ALJ will still 
hold a hearing unless all parties to the hearing tell us in writing 
that we should dismiss the hearing requests. We expect that these 
changes will simplify the process and free up scarce administrative 
resources that we can better use to reduce the hearings level case 
backlog.

DATES: To ensure that your comments are considered, we must receive 
them no later than September 20, 2010.

ADDRESSES: You may submit comments by any one of three methods--
Internet, fax, or mail. Do not submit the same comments multiple times 
or by more than one method. Regardless of which method you choose, 
please state that your comments refer to Docket No. SSA-2007-0092 so 
that we can associate your comments with the correct regulation:
    Caution: You should be careful to include in your comments only 
information that you wish to make publicly available. We strongly urge 
you not to include in your comments any personal information, such as 
Social Security numbers or medical information.
    1. Internet: We strongly recommend this method for submitting your 
comments. Visit the Federal eRulemaking portal at http://www.regulations.gov. Use the Search function of the Web page to find 
docket number SSA-2007-0092 and then submit your comment. Once you 
submit your comment, the system will issue you a tracking number to 
confirm your submission. You will not be able to view your comment 
immediately as we must manually post each comment. It may take up to a 
week for your comment to be viewable.
    2. Fax: Fax comments to (410) 966-2830.
    3. Mail: Address your comments to the Office of Regulations, Social 
Security Administration, 137 Altmeyer Building, 6401 Security 
Boulevard, Baltimore, Maryland 21235-6401.
    Comments are available for public viewing on the Federal 
eRulemaking portal at http://www.regulations.gov or in person, during 
regular business hours, by arranging with the contact person identified 
below.

FOR FURTHER INFORMATION CONTACT: Joshua Silverman, Office of 
Regulations, Social Security Administration, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 594-2128. 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 site, 
Social Security Online, at http://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION:

Electronic Version

    The electronic file of this document is available on the date of 
publication in the Federal Register at http://www.gpoaccess.gov/fr/index.html.

Background

    In most cases, we decide claims for benefits using an 
administrative review process that consists of four levels: Initial 
determination, reconsideration, hearing, and appeal. 20 CFR 404.900 and 
416.1400. We make an initial determination at the first level. A 
claimant who is dissatisfied with the initial determination may request

[[Page 42640]]

reconsideration.\1\ A claimant dissatisfied with the reconsidered 
determination may request a hearing before an ALJ. Finally, if 
dissatisfied with the ALJ's decision, a claimant may request that the 
Appeals Council review that decision.\2\ After a claimant has completed 
these administrative steps and received our final decision, he or she 
may request judicial review of the final decision in Federal district 
court.
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    \1\ For disability claims, ten States participate in a 
``prototype'' test under 20 CFR 404.906 and 416.1406. In these 
States, we eliminated the reconsideration step of the administrative 
review process. Claimants and other parties who are dissatisfied 
with the initial determinations on their disability cases may 
request a hearing before an ALJ. The ten States are: Alabama, 
Alaska, California (Los Angeles North and West Branches), Colorado, 
Louisiana, Michigan, Missouri, New Hampshire, New York, and 
Pennsylvania.
    \2\ We define the words ``determination'' and ``decision'' in 20 
CFR 404.901 and 416.1401. At the initial and reconsideration levels 
of the administrative review process, we issue ``determinations.'' 
ALJs issue ``decisions,'' as does the Appeals Council when it 
reviews an ALJ's decision.
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    We handle requests for ALJ hearings in several ways. Most claimants 
receive a decision from an ALJ.\3\ An ALJ may hold a hearing and issue 
a fully favorable, partially favorable, or unfavorable decision. An ALJ 
may issue a decision without holding an oral hearing if the claimant 
and any other parties waive their right to appear at a hearing or if 
the decision is fully favorable.
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    \3\ An ALJ may also send the case to the Appeals Council with a 
recommended decision or dismiss a request for a hearing. 20 CFR 
404.953(c), 404.957, 416.1453(d), and 416.1457.
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    At the ALJ hearing level, there are two other ways we may issue 
favorable determinations or decisions without holding hearings. A State 
agency or one of our components may issue a fully favorable revised 
determination under the prehearing case review process in 20 CFR 
404.941 and 416.1441. An attorney advisor may issue a fully favorable 
decision under the attorney advisor process in 20 CFR 404.942 and 
416.1442. These processes help us adjudicate cases pending at the 
hearing level more quickly while preserving claimants' right to a 
hearing before an ALJ.

Current Prehearing Case Review

    The prehearing case review process allows us to refer a case back 
to the component that issued the determination under review. That 
component decides whether to revise its determination and issue a fully 
or partially favorable revised determination. We may conduct a 
prehearing case review if:
    1. Additional evidence is submitted;
    2. There is an indication that additional evidence is available;
    3. There is a change in the law or regulations; or
    4. There is an error in the file or some other indication that the 
prior determination may be revised.
    20 CFR 404.941(b), 416.1441(b).
    Our current regulations state that, if we issue a fully favorable 
revised determination, we notify the claimant and all other parties 
that the ALJ will dismiss the hearing request unless a party requests 
that the hearing proceed. The claimant or other party must make this 
request in writing within 30 days after the date we mail the notice of 
the revised determination.
    If we issue a partially favorable revised determination, we notify 
the claimant and all other parties that we will continue with the ALJ 
hearing unless the claimant and all other parties agree to dismiss the 
hearing request. However, our current regulations do not specify how 
the claimant and all other parties must tell us that they agree to 
dismiss this hearing request.

Current Prehearing Decisions by Attorney Advisors

    Attorney advisors in our Office of Disability Adjudication and 
Review may conduct specific prehearing proceedings and, if appropriate, 
make fully favorable decisions based on the record. Attorney advisors 
may conduct prehearing proceedings under circumstances similar to those 
under which we conduct prehearing case reviews. 20 CFR 404.942(b) and 
416.1442(b). If an attorney advisor issues a fully favorable decision, 
we wait 30 days before we dismiss the hearing request. We created the 
30-day period to allow time for a claimant or other party to ask us to 
proceed with the hearing.

Proposed Changes

    Our adjudicative experience shows that claimants who receive a 
fully favorable determination or decision rarely ask us to continue 
with a hearing. Our experience shows that claimants may become confused 
when they receive a notice dismissing their request for a hearing 
several weeks after they received a fully favorable determination or 
decision on their claim. As a result, we spend administrative 
resources: (1) Processing the dismissals of requests for hearing 
because we must wait until the 30-day period ends before we dismiss the 
request for hearing; (2) answering claimants' questions; and (3) 
explaining what the dismissal notice means.
    We believe that changing our procedures would both simplify the 
process and free scarce administrative resources that we can better use 
to reduce the hearings level case backlog.
    Therefore, we propose to revise the way claimants can obtain 
further review fully favorable and partially favorable prehearing case 
review determinations and fully favorable attorney advisor decisions. 
The proposed changes preserve a claimant's right to have an ALJ 
hearing, even when we have issued a fully favorable determination or 
decision under one of these processes.
    As is our current policy, whenever a claimant or other party seeks 
further review of a favorable determination or decision, we consider 
the entire case record and determination or decision. Further review of 
a favorable determination or decision may result in a determination or 
decision that is less favorable or unfavorable to a claimant.

Proposed Procedures for Prehearing Case Reviews

    If we issue a fully favorable revised determination in the 
prehearing case review process, we propose that an ALJ will dismiss a 
request for a hearing soon after the reviewing component issues the 
fully favorable determination. The notice accompanying the ALJ's order 
of dismissal will advise all parties that they have 60 days from the 
date they receive the notice to request that the ALJ vacate the 
dismissal of the hearing request. The administrative law judge will 
extend the 60-day time limit if a party making a request shows that he 
or she had good cause for missing the deadline. If a party timely 
requests that the ALJ vacate the dismissal, the ALJ will vacate the 
dismissal, reinstate the request for a hearing, and offer all parties 
an opportunity for a hearing.
    If we issue a partially favorable determination in the prehearing 
case review process, we propose that an ALJ will proceed to hold a 
hearing unless all parties to the hearing tell us in writing that they 
agree to dismiss the hearing request. If we receive a written 
statement(s) agreeing to a dismissal before an ALJ mails a notice of 
his or her decision, we will dismiss the request for a hearing.
    We propose to include these changes in 20 CFR 404.941, 404.960, 
416.1441, and 416.1460.

Proposed Procedures for Attorney Advisor Prehearing Decisions

    If an attorney advisor issues a fully favorable decision, we 
propose to consider the decision to be a hearing-level decision, and we 
will not issue a notice of dismissal of the hearing request. We propose 
that if a party to the hearing disagrees with the attorney advisor's 
decision for any reason, the

[[Page 42641]]

party will have 60 days after receiving notice of the decision to 
request that an ALJ reinstate the request for a hearing. The ALJ will 
extend the 60-day time limit if the party making the request shows that 
he or she had good cause for missing the deadline. If a party timely 
requests that the ALJ reinstate the request for a hearing, the ALJ will 
reinstate the request for a hearing and offer all parties to the 
hearing an opportunity for a hearing. We will process the fully 
favorable attorney advisor's decision while the hearing proceeds 
normally.
    We propose to include these changes in 20 CFR 404.942 and 416.1442.

Other Changes

    We propose to change ``wholly favorable'' to ``fully favorable'' in 
20 CFR 404.941, 404.948, 416.1441, and 416.1448. We also propose to 
make additional changes for clarity in 20 CFR 404.948, 404.960, 
416.1448, and 416.1460. These minor changes would make the language in 
these sections consistent with other related sections but would not 
alter their meaning.
    Finally, if we issue these proposed rules as final rules, we will 
review and determine whether we need to revise Social Security Ruling 
97-2p, which explains our current procedures for prehearing case 
reviews when new medical evidence is submitted.

Clarity of These Proposed Rules

    Executive Order (E.O.) 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 them 
easier to understand.
    For example:
     Would more, but shorter, sections be better?
     Are the requirements in the rules clearly stated?
     Have we organized the material to suit your needs?
     Could we improve clarity by adding tables, lists, or 
diagrams?
     What else could we do to make the rules easier to 
understand?
     Do the rules contain technical language or jargon that is 
not clear?
     Would a different format make the rules easier to 
understand, e.g., grouping and order of sections, use of headings, 
paragraphing?

When Will We Start To Use These Rules?

    We will not use these rules until we evaluate public comments and 
publish final rules in the Federal Register. All final rules we issue 
include an effective date. We will continue to use our current rules 
until that date. If we publish final rules, we will include a summary 
of relevant comments we received, responses to them, and an explanation 
of how we will apply the new rules.

Regulatory Procedures

Executive Order 12866

    We 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. Thus, OMB 
reviewed them.

Regulatory Flexibility Act

    We certify that these proposed rules will not have a significant 
economic impact on a substantial number of small entities because they 
only affect individuals. Therefore, the Regulatory Flexibility Act, as 
amended, does not require us to prepare a regulatory flexibility 
analysis.

Paperwork Reduction Act

    These regulations impose no new reporting or recordkeeping 
requirements and are not subject to OMB clearance.

(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).

Michael J. Astrue,
Commissioner of Social Security.
    For the reasons set forth in the preamble, we propose to amend 
title 20 of the Code of Federal Regulations part 404 subpart J and part 
416 subpart N as set forth below:

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

Subpart J--[Amended]

    1. The authority citation for subpart J of part 404 continues 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)); 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); sec. 202, Pub. L. 108-203, 118 
Stat. 509 (42 U.S.C. 902 note).

    2. Amend Sec.  404.941 by revising paragraphs (c), (d), and, (e) to 
read as follows:


Sec.  404.941  Prehearing case review.

* * * * *
    (c) Notice of a prehearing revised determination. If we revise the 
determination in a prehearing case review, we will mail a written 
notice of the revised determination to all parties at their last known 
addresses. We will state the basis for the revised determination and 
advise all parties of the effect of the revised determination on the 
request for a hearing.
    (d) Effect of a fully favorable revised determination. If the 
revised determination is fully favorable to you, we will tell you in 
the notice that an administrative law judge will dismiss the request 
for a hearing. When the administrative law judge dismisses the request 
for a hearing, the notice of dismissal will tell you that, if you or 
another party to the hearing disagrees with the revised determination 
for any reason, you or another party may request that the 
administrative law judge vacate the dismissal and reinstate your 
request for a hearing. If you wish to request that the administrative 
law judge vacate the dismissal and reinstate your hearing request, you 
must do so within 60 days after you receive the dismissal notice. The 
administrative law judge will extend the time limit if you show that 
you had good cause for missing the deadline. The administrative law 
judge will use the standards in Sec.  404.911 to determine whether good 
cause exists. If the request is timely, an administrative law judge 
will vacate the dismissal, reinstate the request for a hearing, and 
offer you an opportunity for a hearing.
    (e) Effect of a partially favorable revised determination. If the 
revised determination is partially favorable to you, we will tell you 
in the notice what was not favorable. We will also tell you that an 
administrative law judge will proceed to hold the hearing you requested 
unless you and all other parties to the hearing agree in writing to 
dismissal of the request for a hearing. If we receive the written 
statement(s) agreeing to dismissal of the request for a hearing before 
an administrative law judge mails a notice of his or her

[[Page 42642]]

hearing decision, an administrative law judge will dismiss the request 
for a hearing.
    3. Amend Sec.  404.942 by revising paragraphs (d), (e) introductory 
text, (e)(1), and (f)(3) to read as follows:


Sec.  404.942  Prehearing proceedings and decisions by attorney 
advisors.

* * * * *
    (d) Notice of a decision by an attorney advisor. If the attorney 
advisor issues a fully favorable decision under this section, we will 
mail a written notice of the decision to all parties at their last 
known addresses. We will state the basis for the decision and advise 
all parties that, if a party disagrees with the decision for any 
reason, the party may request that an administrative law judge 
reinstate the request for a hearing. If a party wishes to request that 
the administrative law judge reinstate the hearing request, the party 
must do so within 60 days after receiving notice of the decision. The 
administrative law judge will extend the time limit if you show that 
you had good cause for missing the deadline. The administrative law 
judge will use the standards in Sec.  404.911 to determine whether good 
cause exists. If the request is timely, an administrative law judge 
will reinstate the request for a hearing and offer you an opportunity 
for a hearing.
    (e) Effect of an attorney advisor's decision. An attorney advisor's 
decision under this section is binding unless--
    (1) You or another party to the hearing submits a timely request 
that an administrative law judge reinstate the request for a hearing 
under paragraph (d) of this section;
* * * * *
    (f) * * *
    (3) Make the decision of an attorney advisor under paragraph (d) of 
this section subject to review by the Appeals Council if the Appeals 
Council decides to review the decision of the attorney advisor anytime 
within 60 days after the date of the decision under Sec.  404.969.
* * * * *
    4. Amend Sec.  404.948 by revising the second sentence of paragraph 
(a), and paragraph (b)(1)(ii), to read as follows:


Sec.  404.948  Deciding a case without an oral hearing before an 
administrative law judge.

    (a) Decision fully favorable. * * * The notice of the decision will 
state that you have the right to an oral hearing and to examine the 
evidence on which the ALJ based the decision.
    (b) * * *
    (1) * * *
    (ii) You live outside the United States, you do not inform us that 
you wish to appear, and there are no other parties who wish to appear.
* * * * *
    5. Revise Sec.  404.960 to read as follows:


Sec.  404.960  Vacating a dismissal of a request for a hearing before 
an administrative law judge.

    (a) Except as provided in paragraph (b) of this section, an 
administrative law judge or the Appeals Council may vacate a dismissal 
of a request for a hearing if, within 60 days after the date you 
receive the dismissal notice, you request that we vacate the dismissal 
and show good cause why we should not have dismissed the request for a 
hearing. The Appeals Council may decide to vacate a dismissal on its 
own initiative within 60 days after we mail the notice of dismissal. 
The Appeals Council will inform you in writing if it vacates the 
dismissal.
    (b) If an administrative law judge dismissed your request for a 
hearing because you received a fully favorable revised determination 
under the prehearing case review process in Sec.  404.941, but you 
still wish to proceed with the hearing, then you must follow the 
procedure in Sec.  404.941(d) to request that an administrative law 
judge vacate his or her order dismissing your request for a hearing.

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

Subpart N--[Amended]

    6. The authority citation for subpart N of part 416 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); sec. 202, Pub. 
L. 108-203, 118 Stat. 509 (42 U.S.C. 902 note).

    7. Amend Sec.  416.1441 by revising paragraphs (c), (d), and, (e) 
to read as follows:


Sec.  416.1441  Prehearing case review.

* * * * *
    (c) Notice of a prehearing revised determination. If we revise the 
determination in a prehearing case review, we will mail a written 
notice of the revised determination to all parties at their last known 
addresses. We will state the basis for the revised determination and 
advise all parties of the effect of the revised determination on the 
request for a hearing.
    (d) Effect of a fully favorable revised determination. If the 
revised determination is fully favorable to you, we will tell you in 
the notice that an administrative law judge will dismiss the request 
for a hearing. When the administrative law judge dismisses the request 
for a hearing, the notice of dismissal will tell you that, if you or 
another party to the hearing disagrees with the revised determination 
for any reason, you or another party may request that the 
administrative law judge vacate the dismissal and reinstate your 
request for a hearing. If you wish to request that the administrative 
law judge vacate the dismissal and reinstate your hearing request, you 
must do so within 60 days after you receive the dismissal notice. The 
administrative law judge will extend the time limit if you show that 
you had good cause for missing the deadline. The administrative law 
judge will use the standards in Sec.  416.1411 to determine whether 
good cause exists. If the request is timely, an administrative law 
judge will vacate the dismissal, reinstate the request for a hearing, 
and offer you an opportunity for a hearing.
    (e) Effect of a partially favorable revised determination. If the 
revised determination is partially favorable to you, we will tell you 
in the notice what was not favorable. We will also tell you that an 
administrative law judge will proceed to hold the hearing you requested 
unless you and all other parties to the hearing agree in writing to 
dismissal of the request for a hearing. If we receive the written 
statement(s) agreeing to dismissal of the request for a hearing before 
an administrative law judge mails a notice of his or her hearing 
decision, an administrative law judge will dismiss the request for a 
hearing.
    8. Amend Sec.  416.1442 by revising paragraphs (d), (e) 
introductory text, (e)(1), and (f)(3) to read as follows:


Sec.  416.1442  Prehearing proceedings and decisions by attorney 
advisors.

* * * * *
    (d) Notice of a decision by an attorney advisor. If the attorney 
advisor issues a fully favorable decision under this section, we will 
mail a written notice of the decision to all parties at their last 
known addresses. We will state the basis for the decision and advise 
all parties that, if a party disagrees with the decision for any 
reason, the party may request that an administrative law judge 
reinstate the request for a hearing. If a party wishes to request that 
the administrative law judge reinstate the hearing request, the party 
must do so within 60 days after receiving notice of the decision. The 
administrative law judge will extend the time limit if you show that 
you had good cause for missing the deadline. The administrative law 
judge will use the standards in Sec.  416.1411 to determine

[[Page 42643]]

whether good cause exists. If the request is timely, an administrative 
law judge will reinstate the request for a hearing and offer you an 
opportunity for a hearing.
    (e) Effect of an attorney advisor's decision. An attorney advisor's 
decision under this section is binding unless--
    (1) You or another party to the hearing submits a timely request 
that an administrative law judge reinstate the request for a hearing 
under paragraph (d) of this section;
* * * * *
    (f) * * *
    (3) Make the decision of an attorney advisor under paragraph (d) of 
this section subject to review by the Appeals Council if the Appeals 
Council decides to review the decision of the attorney advisor anytime 
within 60 days after the date of the decision under Sec.  416.1469.
* * * * *
    9. Amend Sec.  416.1448 by revising the second sentence of 
paragraph (a), and paragraph (b)(1)(ii), to read as follows:


Sec.  416.1448  Deciding a case without an oral hearing before an 
administrative law judge.

    (a) Decision fully favorable. * * * The notice of the decision will 
state that you have the right to an oral hearing and to examine the 
evidence on which the ALJ based the decision.
    (b) * * *
    (1) * * *
    (ii) You live outside the United States, you do not inform us that 
you wish to appear, and there are no other parties who wish to appear.
* * * * *
    10. Revise Sec.  416.1460 to read as follows:


Sec.  416.1460  Vacating a dismissal of a request for a hearing before 
an administrative law judge.

    (a) Except as provided in paragraph (b) of this section, an 
administrative law judge or the Appeals Council may vacate a dismissal 
of a request for a hearing if, within 60 days after the date you 
receive the dismissal notice, you request that we vacate the dismissal 
and show good cause why we should not have dismissed the request for a 
hearing. The Appeals Council may decide to vacate a dismissal on its 
own initiative within 60 days after we mail the notice of dismissal. 
The Appeals Council will inform you in writing if it vacates the 
dismissal.
    (b) If an administrative law judge dismissed your request for a 
hearing because you received a fully favorable revised determination 
under the prehearing case review process in Sec.  416.1441, but you 
still wish to proceed with the hearing, then you must follow the 
procedure in Sec.  416.1441(d) to request that an administrative law 
judge vacate his or her order dismissing your request for a hearing.

[FR Doc. 2010-17896 Filed 7-21-10; 8:45 am]
BILLING CODE 4191-02-P