[Federal Register Volume 78, Number 147 (Wednesday, July 31, 2013)]
[Proposed Rules]
[Pages 46309-46310]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-18360]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Docket No. SSA 2013-0011]


Rules of Administrative Finality

AGENCY: Social Security Administration (SSA)

ACTION: Notice and request for comments.

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SUMMARY: We are requesting information from the public regarding 
whether and how we should change our rules of administrative finality. 
These rules govern when we can reopen and revise a determination or 
decision that has become final and is no longer subject to 
administrative or judicial review. We are requesting information about 
several possible ways to change various aspects of our administrative 
finality rules. We are interested in obtaining information about issues 
such as whether and how we should revise the rules that govern the 
timeframes in which we can reopen a determination or decision, and 
whether and how we should revise the rules that govern the diligent 
pursuit of an investigation. We are also interested in obtaining 
information about whether we should adopt rules that would address our 
ability to make prospective changes to the amount of an individual's 
benefits without making changes for months in which the individual has 
already received payment. We are requesting your comments on several 
questions that we address below.

DATES: To ensure that your comments are considered, we must receive 
them no later than September 30, 2013.

ADDRESSES: You may submit written 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-
2013-0011, so that we may associate your comments with the correct 
activity.
    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.
     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-2013-0011, 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.
     Fax: Fax comments to (410) 966-2830.
     Mail: Mail your comments to the Office of Regulations and 
Reports Clearance, Social Security Administration, 107 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: Zeenat Kolia, Office of Income 
Security Programs, Social Security Administration, 6401 Security 
Boulevard, Baltimore, Maryland 21235-6401, 410-965-8629. 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:

Background

    An initial determination is a determination we make that is subject 
to administrative and judicial review. Generally, an initial 
determination resolves the legal or factual issues affecting your 
entitlement or eligibility as provided by the Social Security Act 
(Act). Some examples of initial determinations are determinations about 
your entitlement to benefits, the benefit amount you receive, the 
termination of your benefits, and any overpayments or underpayments 
that may occur. Initial determinations are final and binding unless you 
request an appeal within the appropriate timeframe or we reopen and 
revise the initial determination under our rules of administrative 
finality.
    The rules of administrative finality govern whether we may reopen 
and revise determinations or decisions that are no longer subject to 
administrative and judicial review. The administrative finality rules 
that allow us to reopen and revise determinations or decisions only in 
specific situations and within specific timeframes were first put in 
place to help ensure that individuals could rely on the determinations 
and decisions we made in their claims.

Current Rules for Reopening

    Our rules of administrative finality are located at 20 CFR 404.987-
404.996 for title II claims and at 20 CFR 416.1487-416.1494 for title 
XVI claims.
    Some of the timeframes for reopening are different for title II and 
title XVI. Currently, for title II claims, we may reopen a 
determination or decision:
     Within 12 months of the date of the notice of the initial 
determination for any reason;
     Within 4 years of the date of the notice of the initial 
determination if we find good cause to reopen the determination or 
decision; or
     At any time in certain situations, such as when fraud or 
similar fault is involved.
    For title XVI claims, we may reopen a determination or decision:
     Within 12 months of the date of the notice of the initial 
determination for any reason;
     Within 2 years of the date of the notice of the initial 
determination if we find good cause to reopen the determination or 
decision; or
     At any time only if fraud or similar fault is involved.

[[Page 46310]]

    For both title II and title XVI, after we have reopened a 
determination or decision, we apply the concept of diligent pursuit on 
cases where the applicable reopening period ends but we have not 
completed our investigation. We will presume diligent pursuit to have 
been met if we conclude the investigation and if needed, revise the 
determination or decision within 6 months from the date we began the 
investigation. If we have not diligently pursued the investigation to 
its conclusion, we will revise the determination or decision only if it 
will be favorable to you.
    In addition, under our current rules of administrative finality, if 
we cannot reopen the case, we also will not make any prospective 
changes to the amount of an individual's benefits. For example, if we 
erroneously entitled you to a larger payment amount than was due, we 
will continue to pay you the larger benefit amount even though we know 
it is wrong.
    Why are we considering changing our rules of administrative 
finality?
    We are considering changing our rules of administrative finality 
for a variety of reasons:
    1. We take our responsibility as effective stewards of the trust 
funds very seriously. Modifying our rules would enable us to take 
corrective action on more cases, and could decrease the amount of 
improper payments that we make.
    2. Our current rules are complex to administer. The fact that our 
rules under title II and title XVI contain different timeframes for 
reopening for good cause can result in confusion for our adjudicators 
and the public, particularly in situations where an individual is 
concurrently receiving benefits under title II and title XVI of the 
Act.
    3. The current rules may prevent us from making changes regardless 
of the possible outcome for the individual. For example, if an 
individual presents or we discover new and material evidence after the 
time period that would allow us to reopen, we cannot take corrective 
action and revise the determination or decision. Modifying our rules to 
change certain timeframes for reopening may enable us to take 
corrective actions on more cases.
    4. The Office of the Inspector General has recommended that we 
review our rules on administrative finality to find ways that will 
allow us to correct more erroneous payments.
    5. Some of our administrative finality rules have not been revised 
in sixty years. Over the years, there has been an increase in our 
workloads and the complexity of our programs. Updating the rules would 
allow us to reflect these changes.
    6. Finally, modifying our current rules would enable us to 
streamline and simplify our rules on administrative finality. We 
believe this would allow us to operate more efficiently in a 
challenging, limited-resource environment.

Request for Comments

    We are requesting comments concerning whether and how we should 
change our rules of administrative finality. We ask that, in preparing 
comments, you address questions such as:
    1. Should the timeframe for reopening for good cause be consistent 
for both title II and title XVI? If so, what should that timeframe be?
    2. Should we extend the timeframe for reopening for any reason 
under both title II and title XVI? If so, what would a reasonable 
timeframe be? If not, how would you address concerns that the current 
12-month timeframe does not give us adequate time to correct errors in 
determinations or decisions without applying complex good cause rules?
    3. Should we revise our rules to provide that we can change an 
individual's current and future payments, even if we cannot reopen a 
determination or decision to correct previously issued payments? If 
not, what actions would you take to address the Office of the Inspector 
General's September 2007 report \1\ that reviewed our title II 
administrative finality rules and estimated that we would pay 
approximately an additional $50 million in incorrect payments in the 
future because we did not correct ongoing benefits?
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    \1\ Social Security Administration, Office of the Inspector 
General, Administrative Finality in the Old-Age, Survivors and 
Disability Insurance Program (Audit No. A-01-07-27029) (September 
2007), at page 3 (available at: http://oig.ssa.gov/sites/default/files/audit/full/pdf/A-01-07-27029.pdf).
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    4. Should we revise our rules on diligent pursuit? If so, what 
would be a reasonable timeframe? Or should we eliminate diligent 
pursuit and instead require that we both reopen and complete any 
revisions during the applicable reopening timeframe?
    5. Are there any other aspects of our administrative finality rules 
that we should consider revising?
    Please see the information under ADDRESSES earlier in this document 
for methods to give us your comments. We will not respond to your 
comments, but we will consider them as we review our policies and 
instructions to determine if we should revise or update them.

    Dated: July 24, 2013.
Carolyn W. Colvin,
Acting Commissioner of Social Security.
[FR Doc. 2013-18360 Filed 7-30-13; 8:45 am]
BILLING CODE 4191-02-P