[Federal Register Volume 60, Number 111 (Friday, June 9, 1995)]
[Proposed Rules]
[Pages 30482-30487]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-14037]
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SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
RIN 0960-AE06
Administrative Review Process, Testing Modifications to
Prehearing Procedures and Decisions by Adjudication Officers
AGENCY: Social Security Administration.
ACTION: Proposed rule.
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SUMMARY: We propose to amend our rules to establish the authority to
test the position of an adjudication officer who, under the Plan for a
New Disability Claim Process approved by the Commissioner of Social
Security in September 1994 (the disability redesign plan), would be the
focal point for all prehearing activities when a request for a hearing
before an administrative law judge (ALJ) is filed. The adjudication
officer is an integral element of the disability redesign plan. We
expect that our test of the adjudication officer position will provide
us with sufficient information to determine the effect of the position
on the hearing process. This proposed rule only refers to the changes
to the disability procedures we will test. Unless specified, all other
regulations related to the disability determination process remain
unchanged.
DATES: To be sure that your comments are considered, we must receive
them no later than July 10, 1995.
ADDRESSES: Comments should be submitted in writing to the Commissioner
of Social Security, P.O. Box 1585, Baltimore, Maryland 21235, sent by
telefax to (410) 966-2830, sent by E-mail to regulations@ssa.gov,''
or delivered to the Division of Regulations and Rulings, Social
Security Administration, 3-B-1 Operations Building, 6401 Security
Boulevard, Baltimore, Maryland 21235, between 8:00 a.m. and 4:30 p.m.
on regular business days. Comments may be inspected during these same
hours by making arrangements with the contact person shown below.
The electronic file of this document is available on the Federal
Bulletin Board (FBB) at 9:00 a.m. on the date of publication in the
Federal Register. To download the file, modem dial (202) 512-1387. The
FBB instructions will explain how to download the file and the fee.
This file is in Wordperfect and will remain on the FBB during the
comment period.
FOR FURTHER INFORMATION CONTACT: Harry J. Short, Legal Assistant,
Division of Regulations and Rulings, Social Security Administration,
6401 Security Boulevard, Baltimore, Maryland 21235, (410) 965-6243.
SUPPLEMENTARY INFORMATION:
Background
The Social Security Administration (SSA) decides claims for Social
Security benefits under title II of the Social Security Act (the Act)
and for Supplemental Security Income (SSI) benefits under title XVI of
the Act in an administrative review process that generally consists of
four steps. Claimants who are not satisfied with the initial
determination we make on a claim may request reconsideration. Claimants
who are not satisfied with our reconsidered determination may request a
hearing before an ALJ, and claimants who are dissatisfied with an ALJ's
decision may request review by the Appeals Council. Claimants who have
completed these steps and who are not satisfied with our final
decision, may request judicial review of the decision in the Federal
courts.
Generally, when a claim is filed for Social Security or SSI
benefits based on disability, a State agency makes the initial and
reconsideration disability determination for us. A hearing requested
after we have made a reconsideration determination is conducted by an
ALJ in one of the 132 hearing offices we have nationwide.
Applications for Social Security and SSI benefits based on
disability have risen dramatically in recent years. The number of new
disability claims SSA received in Fiscal Year (FY) 1994--3.56 million--
represented a 40 percent increase over the number received in FY 1990--
2.55 million. Requests for an ALJ hearing also have increased
dramatically. In FY 1994, our hearing offices had almost 540,000
hearing receipts, and most of these receipts were filed by persons
claiming disability benefits. In that year, the number of hearing
receipts we received exceeded the number of receipts we received in FY
1990 by more than 70 percent.
Despite management initiatives that resulted in a record increase
in ALJ productivity in FY 1994 and the hiring of more than 200 new ALJs
and more than 650 new support staff in that year, the number of cases
pending in our hearing offices has reached unprecedented levels--more
than 480,000 at the end of FY 1994.
In order to process this workload the disability redesign plan
contains other changes to the disability determination process by which
SSA plans to decrease processing times while providing world class
service. For example, the disability redesign plan envisions a
streamlined [[Page 30483]] initial disability determination process
which will result in more timely determinations and the elimination of
the reconsideration step in the administrative review process for
disability claims. We expect that one consequence of these initiatives
will be an increase in the number of requests for hearings filed over
the next several years. In light of these growing workload
expectations, and to process more efficiently the hearing requests now
pending at our hearing offices, we are issuing this notice of proposed
rule making (NPRM) which proposes to establish the authority to test
having an adjudication officer conduct prehearing development and, if
appropriate, issue a decision wholly favorable to the claimant.
We expect that use of an adjudication officer process, as described
in our Plan for a New Disability Claim Process, will enable us to
ensure development of a complete record and to issue decisions in a
more efficient manner when a request for a hearing has been filed.
Under this NPRM, we propose initially to test the adjudication officer
position before implementing it as contemplated in the disability
redesign plan. We anticipate that our tests of the adjudication officer
position will provide us with information regarding the effect the
position has on the hearing process currently, and how to best
implement it under the redesigned disability process. We will do this
by testing the adjudication officer position alone and in combination
with one or more of the tests we are conducting pursuant to the final
rule ``Testing Modifications to the Disability Determination
Procedures,'' which was published in the Federal Register on April 24,
1995 (60 FR 20023).
We consider testing and implementation of the adjudication officer
position to be a high priority. It is a complementary approach to
short-term disability processing initiatives we currently are
undertaking which are designed to reduce pending requests for hearings
from more than 480,000 at the end of FY 1994 to 375,000 at the end of
FY 1996. One short-term initiative is set out in the NPRM we published
in the Federal Register on April 14, 1995 (60 FR 19008) to authorize
attorney advisors in our Office of Hearings and Appeals to conduct
certain prehearing proceedings and, where appropriate, issue decisions
which are wholly favorable to the claimant. The principal aim of the
attorney advisor procedures is to expedite decisions on pending
requests for hearings. The adjudication officer process is focused on
making more efficient use of existing resources so that ongoing cases
are processed more timely and in a more efficient manner. This proposed
rule authorizing testing of an adjudication officer process, if
published as a final rule, will allow us to test the effect of a
process that we expect will allow us to better manage the hearing
process in the years to come.
In view of the salutary effect we expect this rule to have on our
ability to improve our service to claimants, and the importance we
place on ensuring that we adjudicate claims timely and accurately, we
are providing a 30-day comment period for this rule rather than the 60-
day period we usually provide. We also believe that a 30-day comment
period is appropriate in this instance because we previously provided
the public with the opportunity to comment on all aspects of the
disability redesign plan, including the establishment of the
adjudication officer position. We believe that for these reasons, a 30-
day comment period is sufficiently long to allow the public a
meaningful opportunity to comment on the proposed rule in accordance
with Executive Order 12866.
The proposed rules are explained below in more detail.
Prehearing Procedures Under the Disability Redesign Plan
On April 15, 1994, SSA published a notice in the Federal Register
(59 FR 18188), setting out a proposal to reengineer the initial and
administrative review process we use to determine an individual's
entitlement to Social Security and SSI benefits based on disability.
Comments on this comprehensive and far-reaching proposal were
requested, and during the comment period that began on April 1, 1994,
and ended on June 14, 1994, SSA received, from a broad spectrum of
respondents, over 6,000 written responses and extensive verbal
comments. The commenters expressed their belief that improvements were
needed to provide better service and to manage the claims process more
effectively. While some concerns were expressed, the commenters praised
SSA for taking on the task of redesigning the disability claim process.
On September 7, 1994, the Commissioner of Social Security accepted
the revised disability redesign plan that was submitted for her
approval on June 30, 1994, with the full understanding that some
aspects of the proposal would require research and testing. The plan as
approved by the Commissioner was published in the Federal Register on
September 19, 1994 (59 FR 47887).
The plan anticipates a redesigned, two-level process for deciding
social security and SSI claims based on disability. The claimant's
right of administrative review following an initial determination will
be to request an ALJ hearing. When a hearing is requested, as planned
in the redesigned process, the focal point for prehearing activities
will be an adjudication officer who will work with, among others,
claimants and their representatives. Adjudication officers will have
authority to make decisions wholly favorable to the claimant where such
decisions are warranted by the evidence.
The adjudication officer, together with the claimant and his or her
representative, will have responsibility for ensuring that claims
coming before ALJs are fully developed.
The procedures outlined in the disability redesign plan make the
best use of representatives' services by defining the clear
responsibility on the part of claimants and their representatives to
submit evidence. One of the features of the adjudication officer
process is an informal conference with a claimant's representative to
identify the issues in dispute and to prepare written agreements
regarding those issues which are not in dispute and those issues
proposed for hearing. We would not ask a claimant who does not have a
representative to limit issues prior to the hearing. However, if the
claimant obtains representation subsequent to the AO's conclusion that
the case is ready for a hearing, the case will be returned to the AO
who will conduct an informal conference with the claimant and his
representative.
In this NPRM we propose to amend our rules by adding new
Secs. 404.943 and 416.1443 to establish the authority to test having an
adjudication officer be the focal point for prehearing activities, as
described in the disability redesign plan.
For many years, our hearing offices nationwide have productively
utilized various forms of prehearing development. We have successfully
conducted tests of a standard prehearing development process. Our
recent experience with many of the elements of the adjudication
officer's responsibilities and duties has given us some information
about the effect the establishment of an adjudication officer position
would have on the administrative review process. However, as we believe
that further information will be helpful, we will begin testing the
adjudication officer position as soon as possible after publication of
a final rule in order to [[Page 30484]] assess whether the position
meets the goals of the disability redesign process and whether it will
have an effect on administrative and program expenditures. We propose
that the adjudication officer's functions will be performed when a
hearing before an ALJ is requested. We will be closely managing the
tests of the adjudication officer position to ensure that the
procedures are consistently and effectively applied at all locations.
In accordance with the goals and directives of the National
Performance Review I and II and our disability redesign plan, the
nature of the adjudication officer must be flexible to make the best
use of available program resources consistent with providing world
class service to our customers. Accordingly, the rule as proposed for
testing permits the adjudication officer to be a qualified employee of
the SSA or a State agency that makes disability determinations for us.
The adjudication officer may be located in field offices or program
service centers, in State agencies that make disability determinations
for us, in our Office of Hearings and Appeals, or in our Regional
Office of Program and Integrity Reviews.
Adjudication Officer Qualifications
The adjudication officer will be expected to bring relevant
experience to the position, with additional training provided as may be
essential to complete the preparation of the individual to assume the
full range of duties. The adjudication officer must be qualified to
communicate effectively with the public (including claimant
representatives), in informal conferences and in writing. The
adjudication officer must, of necessity, be able to manage a
substantial caseload, must be able to review independently the claim
file information and determine the need for additional evidence, and
then be able to evaluate that evidence under the applicable provisions
of the Social Security Act, our regulations and rulings. In addition,
where appropriate, the adjudication officer must be able to write a
comprehensive, factually correct and legally sound decision that can be
readily understood by the public.
Evaluation of Implementation of Prehearing Procedures and Decisions by
Adjudication Officers
This NPRM proposes to establish the authority to test
implementation of prehearing procedures involving the adjudication
officer. We plan to test the procedures in multiple sites to provide a
means of determining the effect of the procedures in an operational
environment. Each test will involve a representative mix of geographic
areas and caseloads. Before we commence each test we will publish a
notice in the Federal Register designating the test site and duration
of the test. The notice will also describe when the test will be
conducted in combination with one or more of the tests we are
conducting pursuant to the final rule ``Testing Modifications to the
Disability Determination Procedures.'' We will evaluate test outcomes
against the objectives of the disability redesign:
Is the process user friendly?
Does the process maintain a high level of payment quality?
Does the process take less time?
Is the process efficient?
Does the process result in satisfying work for employees?
One of the most important measures is the effect of the procedures
on overall disability allowance rates. The adjudication officer's
functions are not designed to change the overall allowance rates. In
order to determine whether the prehearing procedures result in
processing improvements consistent with expected outcomes, the
Commissioner of Social Security will review evaluation results on a
quarterly basis. If there is evidence that overall allowance rates
increase or decrease unacceptably, the Commissioner will cease use of,
or make appropriate adjustments to the prehearing procedures consistent
with this regulatory authority.
SSA published a final rule, ``Testing Modifications to the
Disability Determination Procedures,'' at 60 FR 20023 on April 24, 1995
which provided authority for us to test several elements of the
disability redesign plan. In the preamble to that final rule, we
indicated that we plan to test the adjudication officer prehearing
procedures, as well as other aspects of the disability redesign which
do not require regulatory changes, in combination with one or more of
the four models described in that final rule at some test sites. This
continues to be our intention. Such tests will provide us with a body
of information about each individual part of the redesign, as well as
whether the combined effect of the redesign meets our goals of making
the disability process user friendly, more timely and more accurate and
efficient. It will also provide us with information about program
expenditures in connection with the overall redesign.
Regulatory Procedures
Executive Order No. 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that this proposed rule meets the criteria for a
significant regulatory action under Executive Order (E.O.) 12866. Thus
it was subject to OMB review. This rule does not adversely affect
State, local or tribal governments. The administrative costs of the
tests will be covered within budgeted resources. No program costs are
expected. We have not, therefore, prepared a cost/benefit analysis
under E.O. 12866.
Regulatory Flexibility Act
We certify that this regulation will not have a significant
economic impact on a substantial number of small entities because it
affects only individuals. Therefore, a regulatory flexibility analysis
as provided in Pub. L. 96-354, the Regulatory Flexibility Act, is not
required.
Paperwork Reduction Act
This regulation imposes no new reporting or record keeping
requirements requiring OMB clearance.
(Catalog of Federal Domestic Assistance Program Nos. 93.802, Social
Security-Disability Insurance; 93.807, Supplemental Security Income)
List of Subjects
20 CFR Part 404
Administrative practice and procedure, Death benefits, Disability
benefits, Old-Age, Survivors and Disability Insurance, Reporting and
record keeping requirements, Social Security.
20 CFR Part 416
Administrative practice and procedure, Aged, Blind, Disability
benefits, Public assistance programs, Supplemental Security Income
(SSI), Reporting and record keeping requirements.
Dated: May 4, 1995.
Shirley S. Chater,
Commissioner of Social Security.
For the reasons set out in the preamble, subpart J of part 404 and
subpart N of part 416 of chapter III of title 20 of the Code of Federal
Regulations are proposed to be amended as set forth below.
[[Page 30485]]
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
Subpart J--[Amended]
1. The authority citation for subpart J of part 404 is revised to
read as follows:
Authority: Secs. 201(j), 205(a), (b), and (d)-(h), 221(d), 225
and 702(a)(5) of the Social Security Act; (42 U.S.C. 401(j), 405
(a), (b), and (d)-(h), 421(d), 425 and 902(a)(5); 31 U.S.C. 3720A.
2. New Sec. 404.943 is added under the undesignated center heading
``Hearing Before an Administrative Law Judge'' to read as follows:
Sec. 404.943 Responsibilities of the adjudication officer.
(a)(1) General. Under the procedures set out in this section we
will test modifications to the prehearing procedures we follow when you
file a request for a hearing before an administrative law judge in
connection with a claim for benefits based on disability where the
question of whether you are under a disability as defined in
Sec. 404.1505 is at issue. These modifications will enable us to test
the effect of having an adjudication officer be your primary point of
contact after you file a hearing request and before you have a hearing
with an administrative law judge. The tests may be conducted alone, or
in combination with the tests of the modifications to the disability
determination procedures which we conduct under Sec. 404.906. The
adjudication officer, working with you and/or your representative,
identifies issues in dispute, develops evidence, conducts informal
conferences, and conducts other prehearing proceedings as may be
necessary. The adjudication officer has the authority to make a
decision wholly favorable to you if the evidence so warrants. If the
adjudication officer does not make a decision on your claim, your
hearing request will be assigned to an administrative law judge for
further proceedings.
(2) Procedures for cases included in the tests. Prior to commencing
tests of the adjudication officer position in selected site(s), we will
publish a notice in the Federal Register. The notice will describe
where the specific test site(s) will be and the duration of the
test(s). We will also state whether the tests of the adjudication
officer position in each site will be conducted alone, or in
combination with the test of the modifications to the disability
determination process which we conduct under Sec. 404.906. The
individuals who participate in the test(s) will be assigned randomly to
a test group in each site where the tests are conducted.
(b)(1) Prehearing procedures conducted by an Adjudication Officer.
When you file a request for a hearing before an administrative law
judge in connection with a claim for benefits based on disability where
the question of whether you are under a disability as defined in
Sec. 404.1505 is at issue, the adjudication officer will conduct an
interview with you. The interview may take place in person, by
telephone, or by videoconference, as the adjudication officer
determines is appropriate under the circumstances of your case. If you
file a request for an extension of time to request a hearing in
accordance with Sec. 404.933(c), the adjudication officer may develop
information on, and may decide in wholly favorable decisions that you
had good cause for missing the deadline for requesting a hearing. To
determine whether you had good cause for missing the deadline, the
adjudication officer will use the standards contained in Sec. 404.911.
(2) Representation. The adjudication officer will provide you with
information regarding the hearing process, including your right to
representation. As may be appropriate, the adjudication officer will
provide you with referral sources for representation, and give you
copies of necessary documents to facilitate the appointment of a
representative. If you have a representative, the adjudication officer
will conduct an informal conference with the representative, in person
or by telephone, to identify the issues in dispute and prepare written
agreements regarding those issues which are not in dispute and those
issues proposed for the hearing. If you decide to proceed without
representation, the AO may hold an informal conference with you. If you
obtain representation subsequent to the AO's conclusion that your case
is ready for a hearing, your case will be returned to the AO who will
conduct an informal conference with you and your representative.
(3) Evidence. You, or your representative, may submit, or may be
asked to obtain and submit, additional evidence to the adjudication
officer. As the adjudication officer determines is appropriate under
the circumstances of your case, the adjudication officer may refer the
claim for further medical or vocational evidence.
(4) Referral for a hearing. The adjudication officer will refer the
prepared claim to the administrative law judge for a hearing when the
development of evidence is complete, and you or your representative
agree that a hearing is ready to be held. At this point, the
administrative law judge conducts all further hearing proceedings,
including scheduling and holding a hearing and issuing a decision or
dismissal of your request for a hearing, as may be appropriate.
(c)(1) Wholly favorable decisions issued by an adjudication
officer. (i) If, after a hearing is requested but before it is held,
the adjudication officer decides that the evidence in your case
warrants a decision which is wholly favorable to you, the adjudication
officer may issue such a decision. For purposes of the tests authorized
under this section, the adjudication officer's decision shall be
considered to be a decision as defined in Sec. 404.901.
(ii) If the adjudication officer issues a decision under this
section, it will be in writing and will give the findings of fact and
the reasons for the decision. The adjudication officer will evaluate
the issues relevant to determining whether or not you are disabled in
accordance with the provisions of the Social Security Act, the rules in
this part and part 422 of this chapter and applicable Social Security
Rulings, which are available from the Superintendent of Documents,
United States Government Printing Office, Washington, DC 20402. For
cases in which the adjudication officer issues a decision, he or she
may determine your residual functional capacity in the same manner that
an administrative law judge is authorized to do so in Sec. 404.1546.
The adjudication officer may also evaluate the severity of your mental
impairments in the same manner that an administrative law judge is
authorized to do so under Sec. 404.1520a. The adjudication officer's
decision will be based on the evidence which is included in the record
and, subject to paragraph (c)(2) of this section, will complete the
actions that will be taken on your request for hearing. A copy of the
decision will be mailed to all parties at their last known address. We
will tell you in the notice that the administrative law judge will not
hold a hearing unless a party to the hearing requests that the hearing
proceed. A request to proceed with the hearing must be made in writing
within 30 days after the date the notice of the decision of the
adjudication officer is mailed.
(2) Effect of a decision by an adjudication officer. A decision by
an adjudication officer which is wholly favorable to you under this
section, and notification thereof, completes the administrative action
on your request for hearing and is binding on all parties to the
hearing and not subject to further review, unless-- [[Page 30486]]
(i) You or another party requests that the hearing continue, as
provided in paragraph (c)(1) of this section;
(ii) The Appeals Council decides to review the decision on its own
initiative under the authority provided in Sec. 404.969;
(iii) The decision is revised under the procedures explained in
Secs. 404.987 through 404.989; or
(iv) In a case remanded by a Federal court, the Appeals Council
assumes jurisdiction under the procedures in Sec. 404.984.
(3) Fee for a representative's services. The adjudication officer
may authorize a fee for your representative's services if the
adjudication officer makes a decision on your claim that is wholly
favorable to you, and you are represented. The actions of, and any fee
authorization made by, the adjudication officer with respect to
representation will be made in accordance with the provisions of
subpart R of this part.
(d) Who may be an adjudication officer. The adjudication officer
described in this section may be an employee of the Social Security
Administration or a State agency that makes disability determinations
for us.
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
Subpart N--[Amended]
1. The authority citation for subpart N of part 416 is revised to
read as follows:
Authority: Sec. 702(a)(5), 1631, and 1633 of the Social Security
Act; (42 U.S.C. 902(a)(5), 1383, and 1383b.)
2. New Sec. 416.1443 is added under the undesignated center heading
``Hearing Before an Administrative Law Judge'' to read as follows:
Sec. 416.1443 Responsibilities of the adjudication officer.
(a)(1) General. Under the procedures set out in this section we
will test modifications to the prehearing procedures we follow when you
file a request for a hearing before an administrative law judge in
connection with a claim for benefits based on disability where the
question of whether you are under a disability as defined in
Secs. 416.905 and 416.906 is at issue. These modifications will enable
us to test the effect of having an adjudication officer be your primary
point of contact after you file a hearing request and before you have a
hearing with an administrative law judge. The tests may be conducted
alone, or in combination with the tests of the modifications to the
disability determination procedures which we conduct under
Sec. 416.1406. The adjudication officer, working with you and/or your
representative, identifies issues in dispute, develops evidence,
conducts informal conferences, and conducts other prehearing
proceedings as may be necessary. The adjudication officer has the
authority to make a decision wholly favorable to you if the evidence so
warrants. If the adjudication officer does not make a decision on your
claim, your hearing request will be assigned to an administrative law
judge for further proceedings.
(2) Procedures for cases included in the tests. Prior to commencing
tests of the adjudication officer position in selected site(s), we will
publish a notice in the Federal Register. The notice will describe
where the specific test site(s) will be and the duration of the
test(s). We will also state whether the tests of the adjudication
officer position in each site will be conducted alone, or in
combination with the test of the modifications to the disability
determination process which we conduct under Sec. 416.1406. The
individuals who participate in the test(s) will be assigned randomly to
a test group in each site where the tests are conducted.
(b)(1) Prehearing procedures conducted by an Adjudication Officer.
When you file a request for a hearing before an administrative law
judge in connection with a claim for benefits based on disability where
the question of whether you are under a disability as defined in
Secs. 416.905 and 416.906 is at issue, the adjudication officer will
conduct an interview with you. The interview may take place in person,
by telephone, or by videoconference, as the adjudication officer
determines is appropriate under the circumstances of your case. If you
file a request for an extension of time to request a hearing in
accordance with Sec. 416.1433(c), the adjudication officer may develop
information on, and may decide in wholly favorable decisions that you
had good cause for missing the deadline for requesting a hearing. To
determine whether you had good cause for missing the deadline, the
adjudication officer will use the standards contained in Sec. 416.1411.
(2) Representation. The adjudication officer will provide you with
information regarding the hearing process, including your right to
representation. As may be appropriate, the adjudication officer will
provide you with referral sources for representation, and give you
copies of necessary documents to facilitate the appointment of a
representative. If you have a representative, the adjudication officer
will conduct an informal conference with the representative, in person
or by telephone, to identify the issues in dispute and prepare written
agreements regarding those issues which are not in dispute and those
issues proposed for the hearing. If you decide to proceed without
representation, the AO may hold an informal conference with you. If you
obtain representation subsequent to the AO's conclusion that your case
is ready for a hearing, your case will be returned to the AO who will
conduct an informal conference with you and your representative.
(3) Evidence. You, or your representative, may submit, or may be
asked to obtain and submit, additional evidence to the adjudication
officer. As the adjudication officer determines is appropriate under
the circumstances of your case, the adjudication officer may refer the
claim for further medical or vocational evidence.
(4) Referral for a hearing. The adjudication officer will refer the
prepared claim to the administrative law judge for a hearing when the
development of evidence is complete, and you or your representative
agree that a hearing is ready to be held. At this point, the
administrative law judge conducts all further hearing proceedings,
including scheduling and holding a hearing and issuing a decision or
dismissal of your request for a hearing, as may be appropriate.
(c)(1) Wholly favorable decisions issued by an adjudication
officer.
(i) If, after a hearing is requested but before it is held, the
adjudication officer decides that the evidence in your case warrants a
decision which is wholly favorable to you, the adjudication officer may
issue such a decision. For purposes of the tests authorized under this
section, the adjudication officer's decision shall be considered to be
a decision as defined in Sec. 416.1401.
(ii) If the adjudication officer issues a decision under this
section, it will be in writing and will give the findings of fact and
the reasons for the decision. The adjudication officer will evaluate
the issues relevant to determining whether or not you are disabled in
accordance with the provisions of the Social Security Act, the rules in
this part and part 422 of this chapter and applicable Social Security
Rulings which are available from the Superintendent of Documents United
States Government Printing Office, Washington DC 20402. For cases in
which the adjudication officer issues a decision, he or she may
determine your residual functional capacity in the same manner that an
administrative law judge is authorized [[Page 30487]] to do so in
Sec. 416.946. The adjudication officer may also evaluate the severity
of your mental impairments in the same manner that an administrative
law judge is authorized to do so under Sec. 416.920a. The adjudication
officer's decision will be based on the evidence which is included in
the record and, subject to paragraph (c)(2) of this section, will
complete the actions that will be taken on your request for hearing. A
copy of the decision will be mailed to all parties at their last known
address. We will tell you in the notice that the administrative law
judge will not hold a hearing unless a party to the hearing requests
that the hearing proceed. A request to proceed with the hearing must be
made in writing within 30 days after the date the notice of the
decision of the adjudication officer is mailed.
(2) Effect of a decision by an adjudication officer. A decision by
an adjudication officer which is wholly favorable to you under this
section, and notification thereof, completes the administrative action
on your request for hearing and is binding on all parties to the
hearing and not subject to further review, unless--
(i) You or another party requests that the hearing continue, as
provided in paragraph (c)(1) of this section;
(ii) The Appeals Council decides to review the decision on its own
initiative under the authority provided in Sec. 416.1469;
(iii) The decision is revised under the procedures explained in
Secs. 416.1487 through 416.1489; or
(iv) In a case remanded by a Federal court, the Appeals Council
assumes jurisdiction under the procedures in Sec. 416.1484.
(3) Fee for a representative's services. The adjudication officer
may authorize a fee for your representative's services if the
adjudication officer makes a decision on your claim that is wholly
favorable to you, and you are represented. The actions of, and any fee
authorization made by, the adjudication officer with respect to
representation will be made in accordance with the provisions of
subpart O of this part.
(d) Who may be an adjudication officer. The adjudication officer
described in this section may be an employee of the Social Security
Administration or a State agency that makes disability determinations
for us.
[FR Doc. 95-14037 Filed 6-8-95; 8:45 am]
BILLING CODE 4190-29-P
