[Federal Register Volume 62, Number 184 (Tuesday, September 23, 1997)]
[Rules and Regulations]
[Pages 49598-49603]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-25124]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
20 CFR Parts 404 and 416
RIN 0960-AE58
Administrative Review Process, Testing Elimination of the Fourth
Step of Administrative Review in the Disability Claim Process (Request
for Review by the Appeals Council)
ACTION: Final rules.
-----------------------------------------------------------------------
SUMMARY: We are amending our rules to establish authority to test
elimination of the final step in the administrative review process used
in determining claims for Social Security and Supplemental Security
Income (SSI) benefits based on disability. Under the final rules, the
right of appeal for a claimant who is included in the test procedures
and who is dissatisfied with the decision of an administrative law
judge (ALJ) will be to file a civil action in Federal district court,
rather than to request the Appeals Council to review the decision. We
are testing procedures that eliminate the request for Appeals Council
review in furtherance of the Plan for a New Disability Claim Process
that former Commissioner of Social Security Shirley S. Chater approved
in September 1994. Unless specified, all other regulations relating to
the disability determination process and the administrative review
process remain unchanged.
EFFECTIVE DATE: September 23, 1997.
FOR FURTHER INFORMATION CONTACT: Harry J. Short, Legal Assistant,
Division of Regulations and Rulings, Social Security Administration,
6401 Security Boulevard, Baltimore, MD 21235, (410) 965-6243. For
information on eligibility or claiming benefits, call our national
toll-free number, 1-800-772-1213.
SUPPLEMENTARY INFORMATION:
Background
The Social Security Administration (SSA) currently uses a four-step
process in deciding claims for Social Security benefits under title II
of the Social Security Act (the Act) and for SSI benefits under title
XVI of the Act. Claimants who are not satisfied with the initial
determination on their claims may request reconsideration. Claimants
who are not satisfied with the 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 four steps, and who are dissatisfied with the final
decision, may request judicial review of the decision by filing a civil
action in Federal district court. 20 CFR 404.900 and 416.1400.
SSA's Plan for a New Disability Claim Process (59 FR 47887,
September 19, 1994) anticipates establishment of a redesigned, two-step
process for deciding Social Security and SSI claims based on
disability. The redesign plan anticipates that the process for
determining disability can be significantly improved by strengthening
the steps of the process in which we make initial determinations and
provide dissatisfied claimants an opportunity for a hearing before an
ALJ, and by eliminating the reconsideration step and the step in which
claimants request the Appeals Council to review the decisions of ALJs.
In 20 CFR 404.906 and 416.1406 (60 FR 20023, April 24, 1995), we
have established authority to test, singly and in combination, several
model procedures for modifying the disability claims process. Under
that authority, we are testing, in isolation from other possible
changes, a modification of the initial determination step in which a
single decisionmaker, rather than a team composed of a disability
examiner and a medical consultant, makes the initial determination of
disability. In addition, under authority established in 20 CFR 404.943
and 416.1443 (60 FR 47469, September 13, 1995), we are also testing, in
another model for evaluating a possible change in isolation from other
changes, use of an adjudication officer as the focal point for all
prehearing activities in disability cases in which a claimant requests
a hearing before an ALJ.
To assess how the above changes and other elements of the
disability redesign plan would work together in different combinations,
we initiated an integrated test on April 7, 1997, that combines model
procedures for major elements of the redesign plan. As structured under
testing authority established in Secs. 404.906, 404.943, 416.1406, and
416.1443 in combination, this integrated model includes, in addition to
models for the single decisionmaker and the adjudication officer, a
model for procedures to provide a predecision interview conducted by
the single decisionmaker (at which a claimant for benefits based on
disability will have an opportunity to submit further evidence and have
an interview with the initial decisionmaker if the evidence is
insufficient to support a fully favorable initial disability
determination or would require an initial determination denying the
claim), and a model to test eliminating the reconsideration step in
disability claims.
In order to increase our ability to assess the effects of possible
modifications of the disability claim process in combination, we are,
through publication of these final rules, adding new Secs. 404.966 and
416.1466 to our regulations to authorize testing of an additional
modification in our integrated model. These final rules authorize us to
incorporate in the integrated model additional procedures to test
elimination of the step in the disability claim process in which a
claimant requests the Appeals Council to review the hearing decision of
an ALJ.
Our specific goal in testing elimination of the request for Appeals
Council review will be to assess the effects of this change, as it
functions in
[[Page 49599]]
conjunction with other modifications in the disability claim process
included in the integrated model, on: (1) judicial workloads, and (2)
the legal sufficiency of decisions subjected to judicial review. We
consider the effects of the change in those respects to represent the
principal, practical issues bearing on the advisability of eliminating
the request for review step in connection with the planned, overall
redesign of the disability claim process.
Regulatory Provisions
Under new Secs. 404.966 and 416.1466, we will randomly select
approximately one half of the requests for an ALJ hearing in the
integrated model for potential inclusion in the test procedures for
eliminating the request for Appeals Council review. The remaining
requests for hearing in the integrated model will be processed under
our regulations concerning the request for Appeals Council review step
and subsequent judicial review. This will enable us to assess other
modifications tested in the integrated model in association with both
the test procedures for eliminating the request for Appeals Council
review and our existing request for review procedures.
The provisions of Secs. 404.966 and 416.1466 apply only to those
ALJ decisions that have been identified for inclusion in that part of
our integrated model in which the request for review by the Appeals
Council is eliminated. Under these provisions, we will eliminate the
request for review step (which has been established by agency
regulations and is not mandated by the Act) in a case in the integrated
model if: (1) the case has been randomly selected for inclusion in this
aspect of the model, and (2) an ALJ issues a decision in the case that
is less than wholly favorable to the claimant (i.e., unfavorable or
only partially favorable to the claimant). Cases in the integrated
model in which an ALJ issues a wholly favorable decision, dismisses a
request for hearing, or issues a recommended decision will not be
included in this part of the model. These cases will be processed under
our existing procedures for requesting Appeals Council review and
judicial review.
In a case to which the new rules apply, the appeal available to a
claimant who is dissatisfied with the ALJ's decision will be, as the
notice of the decision will advise, filing a civil action in Federal
district court. Requesting review by the Appeals Council will be
eliminated as an appeal and as a prerequisite to seeking judicial
review.
Under Secs. 404.966 and 416.1466, the ALJ's decision will be
binding unless a party to the decision files a civil action, the
Appeals Council decides within a specified time to review the decision
on its own motion under the authority provided in 20 CFR 404.969 and
416.1469, or the decision is revised by the ALJ or the Appeals Council
under the rules on reopening final decisions in 20 CFR 404.987 and
416.1487. A party to the decision will have the right to request the
Appeals Council to grant an extension of time to file a civil action.
Evaluation Procedures
We will evaluate the effect of eliminating the request for review
step on judicial workloads by comparing the rate at which civil actions
are filed by individuals whose claims are processed under the current
administrative review steps in the disability claims process--i.e., the
four step process--to the rate at which civil actions are filed in
cases selected for processing under the test procedures for eliminating
the request for Appeals Council review. We will also consider the rate
at which civil actions are filed in cases in the integrated model in
which we retain the request for Appeals Council review. In addition, we
will collect and evaluate information on the reasons individuals
included in the elimination of the request for review decide either to
pursue or to forgo appeals to district courts.
We will assess the effect of eliminating the request for review on
the legal sufficiency of final decisions by comparing the rates at
which, following the filing of civil actions in cases included in the
integrated model and in a control sample of cases processed under the
current administrative review steps in the disability claims process,
we request court-remand of a case within the period during which the
Commissioner of Social Security may file his answer to a civil action
under section 205(g) of the Act. The Appeals Council, working with
agency counsel, will evaluate the claims in the integrated model and in
the control sample to identify instances in which a court should be
requested (as courts may be under existing procedures) to remand a case
for further administrative action. The information we will collect and
evaluate will include data on the agency's ability to assess the legal
sufficiency of cases on a timely basis without having to file court
motions requesting extensions of the time in which the agency's answer
may be filed.
Public Comments
These regulatory provisions were published in the Federal Register
as a notice of proposed rulemaking (NPRM) on May 16, 1997 (62 FR
26997). We provided the public a 30-day comment period. We received
statements in response to this notice from 10 individuals, including
employees of SSA and attorney and nonattorney representatives of
claimants. We also received comments from a legal services
organization, the American Bar Association, and the Administrative
Office of the United States Courts.
Many of the commenters discussed reasons for believing that the
request for Appeals Council review should be retained either as a
mandatory or an optional step in the disability claim process. These
comments can be viewed as opposing testing of the elimination of the
request for review step on the basis that the need for the step, as it
now exists or as it might be changed under the commenter's suggestions,
is sufficiently clear to rule out testing its elimination. We have
summarized these statements in a single comment to this effect that we
address below with the other substantive comments received.
The American Bar Association welcomed SSA's proposal to study the
Appeals Council's role and endorsed the plan to examine the impact of
eliminating the request for review step, without taking a position with
respect to the specific procedures proposed for testing that impact.
The Administrative Office of the United States Courts reported that the
Federal judiciary continues to be seriously concerned about the impact
of eliminating the request for review by the Appeals Council on the
caseloads of the Federal courts. However, this office supported careful
testing of the proposed changes and thorough analysis of the results as
consistent with the common interests of SSA and the courts in providing
efficient and legally sufficient decisions, and made specific
recommendations, which we address below in our responses to the
comments received, as to how to ensure such testing and analysis.
Because some of the comments were detailed, we condensed,
summarized or paraphrased them. We have, however, tried to summarize
the commenters' views accurately and respond to all of the significant
issues raised by the commenters that are within the scope of the
proposed rules. As we discuss below in responding to the comments, we
have made an addition to the proposed rules to clarify their intent. We
have also responded to comments received by adding to our planned
evaluation design.
Comment: A number of the commenters implicitly or explicitly
[[Page 49600]]
opposed testing elimination of the request for review step in the
disability claim process on the basis that the step is necessary or
worthwhile and should not be eliminated. The wide-ranging reasons cited
for this view included the following: that a shorter process is not
necessarily a fairer process, that SSA should deal with the increase in
the Appeals Council's workloads by increasing its staff and other
support, that claimants may drop out of the process prematurely because
of the costs and other difficulties involved in filing civil actions,
that SSA's workloads will be increased by the filing of new claims by
individuals who leave the administrative appeals process prematurely,
and that the change will result in large increases in caseloads in the
Federal courts.
Response: The reasons cited in support of this comment are
generally similar to reasons for not eliminating the request for review
step we received and considered in developing and publishing the Plan
for a New Disability Claim Process. Many of these reasons have merit,
to one degree or another. However, there are also sound reasons for
believing that eliminating the request for review step would improve
the disability claim process, if carried out in conjunction with other
changes to that process. After reviewing these additional statements in
opposition to eliminating the request for review step, we continue to
believe that we should test eliminating this step in conjunction with
other possible changes for the purpose of gaining additional
information needed to make a fully informed decision.
Comment: One individual opposed the proposed testing of the
elimination of the request for review step on the basis that such
testing could itself adversely affect over 30,000 claimants, lessening
their chances of receiving a favorable ALJ decision (because ALJs will
know in advance that less than wholly favorable decisions in certain
cases will not be subject to a request for Appeals Council review),
without providing the claimants involved in the testing any offsetting
benefits stemming from process unification and changes to the front-end
of the disability claim process.
Response: As we stated in the NPRM, these rules will authorize
elimination of the request for review in only a relatively small number
of cases, which we project at approximately 1900. The test will apply
only in those cases in the integrated model that give rise to a request
for an ALJ hearing (projected at approximately 10,000 cases), that are
then randomly selected for inclusion in the request for review
elimination (contingent on an ALJ's issuance of a less than wholly
favorable decision), and that result in a less than wholly favorable
decision.
We do not know that there would be, as this comment indicates, a
reduction in the likelihood of an allowance decision because the ALJ in
a case knows that the case will not be subject to a request by the
claimant for review by the Appeals Council and will, instead, be
subject to the immediate filing of a civil action to secure judicial
review. However, we believe that we should maximize the relevant,
advance notice that we can give individuals that their cases will be
included in these test procedures of the integrated model (if an ALJ
issues a decision that is less than wholly favorable) and will,
therefore, provide notice of that circumstance in the acknowledgment
letter issued by the adjudication officer at the start of the ALJ
hearing process. We also believe it is important to test these changes
at the ALJ hearing level with the advance knowledge of the participants
in that, if the request for review step were ultimately eliminated, all
the participants in the hearing process would know that the appeal
available to a dissatisfied claimant would be to file a civil action in
Federal district court.
The test of eliminating the request for review will be accompanied
by changes in the front-end of the disability claim process and by
process unification changes. Individuals participating in this test
will participate in other changes being tested in the integrated model,
including the opportunity for a face-to-face interview with the initial
decisionmaker and elimination of the reconsideration step. In addition,
like all claims for benefits based on disability, the claims involved
in the test of eliminating the request for Appeals Council review will
be decided under the significant process unification changes we have
already made to the disability claims process. These changes include
the publication of a series of Social Security Rulings on some of the
most significant issues in disability adjudication (61 FR 34466-34492,
July 2, 1996), and the training of all of our adjudicators, at all
adjudicative levels, in the correct application of these rulings.
Comment: One individual expressed doubt about the methodology of
the proposed test, questioning whether testing elimination of the
request for Appeals Council review in only about 1900 cases will
provide a statistically valid universe for deriving useful information
relative to a process that involves, at the ALJ level, hundreds of
thousands of cases and varied factors affecting case outcome.
Response: Prior to implementing the integrated model in April 1997,
we secured an independent analytical assessment of the completeness,
adequacy, and statistical soundness of our plans for conducting and
evaluating the testing to be carried out in that model, including our
plans for testing elimination of the request for Appeals Council
review. Performed by the Lewin Group, Inc., this assessment concluded
that our test design was fundamentally sound and that, even if
recommendations for improving the test were not implemented, the test
would likely produce valid findings and provide information that
decisionmakers and stakeholders need. Final Report, An Independent
Assessment of the Proposed Structure, Operation, and Evaluation Plans
of the Full Process Model Pilot (hereafter, Final Report), prepared by
the Lewin Group, Inc., March 14, 1997, p. 2. (The ``Full Process Model
Pilot'' is same test that we are herein referring to as the
``integrated model.'')
We have implemented most of the recommendations the Lewin Group
made for improving our test and evaluation procedures. The
recommendations implemented include the recommendation the Lewin Group
made relative to testing elimination of the request for Appeals Council
review (which recommendation concerned when in the process individuals
should be notified that they will not have an opportunity to request
Council review). Final Report, p. 21.
Comment: The Administrative Office of the United States Courts
requested clarification as to which judicial districts will be
affected.
Response: The test of eliminating the request for Appeals Council
review will affect claims of individuals residing in the following ten
States: Arizona, Colorado, Georgia, Kentucky, New York, Pennsylvania,
South Carolina, Tennessee, Utah, and Wisconsin. District courts in
these States will be affected by procedures for testing and evaluating
the request for Appeals Council review elimination.
Comment: The Administrative Office of the United States Courts also
recommended that follow-up surveys be conducted with participants in
the test of eliminating the request for Appeals Council review to
determine what factors went into the decisions of claimants either to
pursue or to forgo appeals to district courts.
Response: Under our evaluation design for the integrated model, we
[[Page 49601]]
intend to conduct surveys to collect information on multiple issues we
are assessing in this model. We believe it would be helpful to collect
and evaluate information regarding the factors concerning court filings
identified by this commenter, and we will do that. Collecting such
information requires no change in the regulatory provisions as
proposed.
Comment: The Administrative Office of the United States Courts also
thought that it would be advantageous to have a set period for the
test, followed by a meaningful review of the results, particularly the
impact upon Federal court filings, prior to a determination being made
as to whether permanent changes would be made to the Appeals Council
review step. This commenter also noted in this regard that the Federal
judiciary would like to be made aware of the results of the proposed
test.
Response: We project that the operational aspects of the integrated
model will be completed within two and a half to three years of our
initiation of testing in the front-end parts of the model in April
1997. This projection includes the estimated time we will require to
conduct pre-answer assessments of the legal sufficiency of new court
cases that arise in cases in the integrated model. No fixed term for
the test can be set because completion of its operational aspects will
depend on when the last civil action is filed in cases in the
integrated model in which the request for review is eliminated or the
Appeals Council denies review. We will then require an additional
period to conclude our evaluation of the test results.
We agree that we should not decide to propose elimination of the
request for review step in the disability claim process until we have
undertaken preliminary consultation with key stakeholders, including
the Administrative Office of the United States Courts, about the
results demonstrated in our testing of the integrated model, and about
the multiple issues that would be involved in proposing such a change.
If a decision were made to propose elimination of the request for
review step after analysis of the test results, we would, of course,
publish an NPRM soliciting public comments on the various changes in
our regulations that would be required to implement this change.
Comment: A private attorney representative of claimants commented
that the proposed regulations are ``contrary to the Act in that they
purport to use the first part of sentence six [of Sec. 205(g) of the
Act] to reclaim ALJ decisions the agency concludes are indefensible or
that the agency does not otherwise want to defend.'' This commenter
believes that the first part of sentence six is properly used only in
very narrow circumstances, such as when a hearing transcript cannot be
prepared, and that Congress did not enact part one of sentence six to
provide the agency with a chance to rehear or redo an inadequate ALJ
decision for the purpose of avoiding a ruling on the merits of the
decision under sentence four of Sec. 205(g).
Response: The agency's procedures for assessing the legal
defensibility of cases filed in Federal court will not be affected by
the final rules, and any court action requested in light of such
assessment will continue to be subject to the relevant provisions of
Sec. 205(g) of the Act. We do not, however, agree that the first clause
of sentence six of Sec. 205(g) must be construed in the restrictive
manner suggested by the commenter, who believed that sentence six
allows remands prior to the filing of the answer only in ``very narrow
circumstances, such as when a hearing transcript cannot be prepared.''
The first clause of sentence six expressly allows the court to remand
cases for further proceedings ``for good cause shown.'' It neither
delineates nor limits the circumstances which may be sufficient for a
demonstration of good cause. Moreover, the legislative history of this
provision recognizes the type of procedural difficulty suggested by the
commenter to be an example of ``good cause,'' not an exclusive
delineation of the circumstances that may constitute good cause. H.R.
Conf. Rep. No. 944, 96th Cong., 2d Sess. 58-59 (1980). Significantly,
virtually every court which has addressed the issue has held that the
defining characteristic of a sentence six, clause one remand lies in
the timing of the remand request, not in its characterization as either
substantive or technical, i.e., if the remand is requested by the
Commissioner prior to the filing of his answer, it falls under sentence
six, and if the Commissioner's request is made subsequent to the filing
of an answer, it may fall under sentence four.
Comment: This same individual also commented that the proposed
rules represent an implicit assertion by the agency that it may extend
the 60 days for taking own motion review to any time before the
Commissioner files his answer.
Response: It is our intent that the Appeals Council shall have
authority to review a case on its own motion under these final rules
only if it decides to review the case, and issues a notice establishing
the occurrence of such a decision, within the 60-day period prescribed
in Secs. 404.969 and 416.1469 (i.e., within 60 days of the date of the
hearing decision). We believe this intent is clear in the rules as
proposed, which indicate in Secs. 404.966(b)(2) and 416.1466(b)(2) that
the own-motion authority the Appeals Council will have under these
rules is the authority provided in Secs. 404.969 and 416.1469.
In test cases in which the request for review by the Appeals
Council is eliminated and the notice of the ALJ's decision advises the
parties of the right to file a civil action, it is also our intent that
the authority of the Appeals Council to decide to review a case on its
own motion shall cease to exist, even if 60 days have not yet lapsed
after the date of the ALJ's decision, as of the date, if any, upon
which the jurisdiction of a Federal district court is established by
the filing of a civil action as provided in the Federal Rules of Civil
Procedure. We have clarified Secs. 404.966(b)(2) and 416.1466(b)(2) to
make this intention clearer. The agency's assessment of a case
following establishment of the jurisdiction of a Federal court will
occur under the provisions of Sec. 205(g) of the Act, 42 U.S.C.
Sec. 405(g).
In a case in which we test elimination of the request for Appeals
Council review, a decision by the Appeals Council to review an ALJ's
decision under Secs. 404.969 or 416.1469 will mean that the Council has
assumed jurisdiction of the case, thereby causing the decision not to
be a final decision of the Commissioner of Social Security subject to
judicial review under Sec. 205(g) of the Act. If the Appeals Council
decides to review one of these cases on its own motion, it must issue a
notice establishing its decision to do so before a civil action is
filed establishing the jurisdiction of a Federal district court.
To clarify our intent in these respects, we have revised
Secs. 404.966(b)(2) and 416.1466(b)(2) in the final rules to include a
provision specifying that the Appeals Council must issue a notice
announcing its decision to review the case on its own motion before the
filing date of any civil action establishing the jurisdiction of a
Federal district court.
Comment: This same individual also commented that the proposed
regulations invite unnecessary litigation over motions for extension of
time to file answer.
Response: As we discussed in the NPRM, our intent is that the
Appeals Council, working with agency counsel, will evaluate the legal
sufficiency of cases in the integrated model and in a
[[Page 49602]]
control sample to determine, within the time in which the Commissioner
of Social Security may file his answer, if we should request the court
to remand the case. We do not expect that these activities will require
the agency frequently to request extensions of time to file answers in
these cases. However, our ability to carry out these evaluations in a
timely fashion is an important consideration and will be one of the
matters we assess in the testing to be conducted under these final
rules.
Based on our analysis of the comments, we are adopting the proposed
rules with the above-discussed addition to Secs. 404.966(b)(2) and
416.1466(b)(2). This addition clarifies the time during which the
Appeals Council may decide on its own motion to review a case to which
these final rules apply. We have also made the following minor
editorial changes in the rules as proposed: we have inserted the words
``in which'' in the final clause of the last sentence of
Secs. 404.966(a) and 416.1466(a), and we have made technical
corrections in the numbering of the subparagraphs of Secs. 404.966(b)
and 416.1466(b). The additions we have made to our evaluation plans
based on consideration of the comments require no changes in the
regulatory provisions as proposed.
Regulatory Procedures
We find good cause for dispensing in this instance with the 30-day
delay in the effective date of a substantive rule provided for by 5
U.S.C. 553(d). For the reasons set forth below, we find that it is
unnecessary and contrary to the public interest to delay the effective
date of these final rules.
We find that delay of the effective date is unnecessary because the
affected individuals will be notified of the possibility of elimination
of the Appeals Council review step more than 30 days before any such
elimination actually occurs. Under new Secs. 404.966 and 416.1466, we
will randomly select cases in the integrated model for contingent
inclusion in the test of eliminating the request for Appeals Council
review after a request for an ALJ hearing is filed and before the
adjudication officer acknowledges receipt of the request for a hearing.
In the cases selected, as we have previously discussed, the
acknowledgement letter the adjudication officer sends will notify the
individual filing the request (and any appointed representative of the
individual) that if an ALJ issues a decision that is less than wholly
favorable, the right of appeal available to the individual will be to
file a civil action in Federal district court.
Elimination of the request for Appeals Council review step will not
occur in a case, if it occurs at all, until after the adjudication
officer sends the case to an ALJ, a hearing is scheduled and held
(except where the parties waive an oral hearing), and the ALJ issues a
decision that is less than wholly favorable. Therefore, even with
elimination of the 30-day delay in the effective date of these final
rules, the substantive change authorized by Secs. 404.966 and 416.1466,
elimination of the request for Appeals Council review step for test
purposes, will not actually occur until after more than 30 days have
elapsed from the date of the publication of these final rules in the
Federal Register.
We also find that delay of the effective date is contrary to the
public interest because it would compromise our ability to evaluate the
effects of the test. By making the rules effective upon publication, we
can immediately implement the planned selection and notice procedures
and thereby make it possible to test elimination of the request for
Appeals Council review in the greatest number of cases in the
integrated model that can be used without reducing our ability also to
test, as we believe we should, use of the other new procedures in the
integrated model with the request for review step. We believe that
maximizing the number of cases in the integrated model in which we can
test elimination of the request for Appeals Council review step, while
also testing retention of that step in conjunction with the other
changes in the integrated model, will contribute to the soundness of
our evaluation of the effects of eliminating this step from the
disability claim process.
Executive Order 12866
We have consulted with the Office of Management and Budget (OMB)
and determined that these rules meet the criteria for a significant
regulatory action under Executive Order 12866. Thus, they were subject
to OMB review. These rules do not adversely affect State, local or
tribal governments. The administrative costs of the test will be
covered within budgeted resources. No program costs are expected to
result from the processing of the test cases. We have not, therefore,
prepared a cost/benefit analysis under Executive Order 12866.
Regulatory Flexibility Act
We certify that these regulations will not have a significant
economic impact on a substantial number of small entities because these
rules affect only individuals. Therefore, a regulatory flexibility
analysis as provided in the Regulatory Flexibility Act, as amended, is
not required.
Paperwork Reduction Act
These regulations impose no new reporting or record keeping
requirements requiring OMB clearance.
(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social
Security-Disability Insurance; 96.006, 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
recordkeeping 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: August 26, 1997.
John J. Callahan,
Acting 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 amended as set forth below.
PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950- )
20 CFR part 404, subpart J, is amended as follows:
1. The authority citation for subpart J of part 404 continues to
read as follows:
Authority: Secs. 201(j), 205(a), (b), (d)-(h), and (j), 221,
225, and 702(a)(5) of the Social Security Act (42 U.S.C. 401(j),
405(a), (b), (d)-(h), and (j), 421, 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. New Sec. 404.966 is added under the undesignated center heading
``APPEALS COUNCIL REVIEW'' to read as follows:
Sec. 404.966 Testing elimination of the request for Appeals Council
review.
(a) Applicability and scope. Notwithstanding any other provision in
this part or part 422 of this chapter, we are establishing the
procedures set out in this section to test elimination of the request
for review by the Appeals Council. These procedures will apply in
randomly selected cases in which we have tested a combination of model
[[Page 49603]]
procedures for modifying the disability claim process as authorized
under Secs. 404.906 and 404.943, and in which an administrative law
judge has issued a decision (not including a recommended decision) that
is less than wholly favorable to you.
(b) Effect of an administrative law judge's decision. In a case to
which the procedures of this section apply, the decision of an
administrative law judge will be binding on all the parties to the
hearing unless --
(1) You or another party file an action concerning the decision in
Federal district court;
(2) The Appeals Council decides to review the decision on its own
motion under the authority provided in Sec. 404.969, and it issues a
notice announcing its decision to review the case on its own motion no
later than the day before the filing date of a civil action
establishing the jurisdiction of a Federal district court; or
(3) The decision is revised by the administrative law judge or the
Appeals Council under the procedures explained in Sec. 404.987.
(c) Notice of the decision of an administrative law judge. The
notice of decision the administrative law judge issues in a case
processed under this section will advise you and any other parties to
the decision that you may file an action in a Federal district court
within 60 days after the date you receive notice of the decision.
(d) Extension of time to file action in Federal district court. Any
party having a right to file a civil action under this section may
request that the time for filing an action in Federal district court be
extended. The request must be in writing and it must give the reasons
why the action was not filed within the stated time period. The request
must be filed with the Appeals Council. If you show that you had good
cause for missing the deadline, the time period will be extended. To
determine whether good cause exists, we will use the standards in
Sec. 404.911.
PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND
DISABLED
20 CFR part 416, subpart N, is amended as follows:
1. The authority citation for subpart N continues 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. 416.1466 is added under the undesignated center heading
``APPEALS COUNCIL REVIEW'' to read as follows:
Sec. 416.1466 Testing elimination of the request for Appeals Council
review.
(a) Applicability and scope. Notwithstanding any other provision in
this part or part 422 of this chapter, we are establishing the
procedures set out in this section to test elimination of the request
for review by the Appeals Council. These procedures will apply in
randomly selected cases in which we have tested a combination of model
procedures for modifying the disability claim process as authorized
under Secs. 416.1406 and 416.1443, and in which an administrative law
judge has issued a decision (not including a recommended decision) that
is less than wholly favorable to you.
(b) Effect of an administrative law judge's decision. In a case to
which the procedures of this section apply, the decision of an
administrative law judge will be binding on all the parties to the
hearing unless --
(1) You or another party file an action concerning the decision in
Federal district court;
(2) The Appeals Council decides to review the decision on its own
motion under the authority provided in Sec. 416.1469, and it issues a
notice announcing its decision to review the case on its own motion no
later than the day before the filing date of a civil action
establishing the jurisdiction of a Federal district court; or
(3) The decision is revised by the administrative law judge or the
Appeals Council under the procedures explained in Sec. 416.1487.
(c) Notice of the decision of an administrative law judge. The
notice of decision the administrative law judge issues in a case
processed under this section will advise you and any other parties to
the decision that you may file an action in a Federal district court
within 60 days after the date you receive notice of the decision.
(d) Extension of time to file action in Federal district court. Any
party having a right to file a civil action under this section may
request that the time for filing an action in Federal district court be
extended. The request must be in writing and it must give the reasons
why the action was not filed within the stated time period. The request
must be filed with the Appeals Council. If you show that you had good
cause for missing the deadline, the time period will be extended. To
determine whether good cause exists, we will use the standards in
Sec. 416.1411.
[FR Doc. 97-25124 Filed 9-22-97; 8:45 am]
BILLING CODE 4190-29-P
