e-CFR data is current as of January 27, 2020
TITLE 20—Employees' Benefits
CHAPTER III—SOCIAL SECURITY ADMINISTRATION PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- )
Subpart A—INTRODUCTION, GENERAL PROVISIONS AND DEFINITIONS
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| General definitions and use of terms. |
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Subpart B—INSURED STATUS AND QUARTERS OF COVERAGE
General
Fully Insured Status
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| How we determine fully insured status. |
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| When we consider a person fully insured based on World War II active military or naval service. |
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| When we consider certain employees of private nonprofit organizations to be fully insured. |
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| Table for determining the quarters of coverage you need to be fully insured. |
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Currently Insured Status
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| How we determine currently insured status. |
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Disability Insured Status
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| How we determine disability insured status. |
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| When you must have disability insured status. |
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| How we determine fully insured status for a period of disability or disability insurance benefits. |
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| When we give you quarters of coverage based on military service to establish a period of disability. |
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Quarters of Coverage
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| What is a quarter of coverage. |
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| How we credit quarters of coverage for calendar years before 1978. |
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| How we credit self-employment income to calendar quarters for taxable years beginning before 1978. |
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| How we credit quarters of coverage for calendar years after 1977. |
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| How we credit self-employment income to calendar years for taxable years beginning after 1977. |
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| When you acquire a quarter of coverage. |
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| When a calendar quarter cannot be a quarter of coverage. |
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Subpart C—COMPUTING PRIMARY INSURANCE AMOUNTS
General
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| What is included in this subpart? |
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| Other regulations related to this subpart. |
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| Methods of computing primary insurance amounts—general. |
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Average-Indexed-Monthly-Earnings Method of Computing Primary Insurance Amounts
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| Average-indexed-monthly-earnings method. |
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| Computing your average indexed monthly earnings. |
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| Computing your primary insurance amount from your average indexed monthly earnings. |
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| Computation where you are eligible for a pension based on your noncovered employment. |
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Average-Monthly-Wage Method of Computing Primary Insurance Amounts
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| Average-monthly-wage method. |
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| Computing your average monthly wage. |
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| Use of benefit table in finding your primary insurance amount from your average monthly wage. |
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Guaranteed Alternative for People Reaching Age 62 After 1978 but Before 1984
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| Steps in computing your primary insurance amount under the guaranteed alternative—general. |
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| Computing your average monthly wage under the guaranteed alternative. |
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| Adjustment of your guaranteed alternative when you become entitled after age 62. |
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Old-Start Method of Computing Primary Insurance Amounts
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| Old-start method—general. |
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| 1977 simplified old-start method. |
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| Use of old-start primary insurance amount as guaranteed alternative. |
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| Computation where you are eligible for a pension based on noncovered employment. |
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Special Computation Rules for People Who Had a Period of Disability
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| Special computation rules for people who had a period of disability. |
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| Subsequent entitlement to benefits less than 12 months after entitlement to disability benefits ended. |
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| Subsequent entitlement to benefits 12 months or more after entitlement to disability benefits ended. |
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Special Minimum Primary Insurance Amounts
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| Special minimum primary insurance amounts. |
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| Computing your special minimum primary insurance amount. |
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Cost-of-Living Increases
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| Cost-of-living increases. |
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| When automatic cost-of-living increases apply. |
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| Indexes we use to measure the rise in the cost-of-living. |
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| When are automatic cost-of-living increases effective? |
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| What are the measuring periods we use to calculate cost-of-living increases? |
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| How is an automatic cost-of-living increase calculated? |
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| Publication of notice of increase. |
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| When does the frozen minimum primary insurance amount increase because of cost-of-living adjustments? |
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| Additional cost-of-living increase. |
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Recomputing Your Primary Insurance Amount
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| Why your primary insurance amount may be recomputed. |
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| Effective date of recomputations. |
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| Recomputation under method other than that used to find your primary insurance amount. |
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| Recomputations for people who reach age 62, or become disabled, or die before age 62 after 1978. |
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| Recomputations performed automatically. |
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| How to request an immediate recomputation. |
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| Recomputing when you are entitled to a monthly pension based on noncovered employment. |
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Recalculations of Primary Insurance Amounts
Subpart D—OLD-AGE, DISABILITY, DEPENDENTS' AND SURVIVORS' INSURANCE BENEFITS; PERIOD OF DISABILITY
General
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| Other regulations related to this subpart. |
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| What are the general rules on benefit amounts? |
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| When you may not be entitled to benefits. |
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Old-Age and Disability Benefits
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| When am I entitled to old-age benefits? |
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| When does my entitlement to old-age benefits begin and end? |
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| How is my old-age benefit amount calculated? |
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| What are delayed retirement credits and how do they increase my old-age benefit amount? |
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| Who is entitled to disability benefits? |
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| When entitlement to disability benefits begins and ends. |
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| How is the amount of my disability benefit calculated? |
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| Who is entitled to a period of disability. |
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| When a period of disability begins and ends. |
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| When you may apply for a period of disability after a delay due to a physical or mental condition. |
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Rules Relating to Continuation of Benefits After Your Impairment Is No Longer Disabling
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| When you are participating in an appropriate program of vocational rehabilitation services, employment services, or other support services. |
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| When your completion of the program, or your continuation in the program for a specified period of time, will increase the likelihood that you will not have to return to the disability benefit rolls. |
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Benefits for Spouses and Divorced Spouses
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| Who is entitled to wife's or husband's benefits. |
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| Who is entitled to wife's or husband's benefits as a divorced spouse. |
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| When wife's and husband's benefits begin and end. |
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| Wife's and husband's benefit amounts. |
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| How do I become entitled to widow's or widower's benefits? |
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| How do I become entitled to widow's or widower's benefits as a surviving divorced spouse? |
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| When does my entitlement to widow's and widower's benefits start and end? |
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| Widow's and widower's benefits amounts. |
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| How do I become entitled to mother's or father's benefits as a surviving spouse? |
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| How do I become entitled to mother's or father's benefits as a surviving divorced spouse? |
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| When mother's and father's benefits begin and end. |
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| Mother's and father's benefit amounts. |
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| Your relationship by marriage to the insured. |
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| Your relationship as wife, husband, widow, or widower under State law. |
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| Your relationship as wife, husband, widow, or widower based upon a deemed valid marriage. |
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| “Living in the same household” defined. |
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| When is a child living with me in my care? |
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| When is a child living apart from me in my care? |
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Child's Benefits
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| Who is entitled to child's benefits? |
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| Who may be reentitled to child's benefits? |
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| When does my entitlement to child's benefits begin and end? |
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| Your relationship to the insured. |
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| Who is the insured's natural child? |
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| Who is the insured's legally adopted child? |
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| Who is the insured's stepchild? |
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| Who is the insured's grandchild or stepgrandchild? |
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| Who is the insured's equitably adopted child? |
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| When a child is dependent upon the insured person. |
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| When a natural child is dependent. |
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| When a legally adopted child is dependent. |
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| When is a stepchild dependent? |
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| When is a grandchild or stepgrandchild dependent? |
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| When an equitably adopted child is dependent. |
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| “Contributions for support,” “one-half support,” and “living with” the insured defined—determining first month of entitlement. |
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| When you are a “full-time elementary or secondary school student”. |
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| When you are considered a full-time student during a period of nonattendance. |
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Parent's Benefits
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| Who is entitled to parent's benefits? |
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| When parent's benefits begin and end. |
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| Parent's benefit amounts. |
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| Parent's relationship to the insured. |
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Lump-Sum Death Payment
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| Who is entitled to the lump-sum death payment as a widow or widower who was living in the same household? |
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| Who is entitled to the lump-sum death payment when there is no widow(er) who was living in the same household? |
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Subpart E—DEDUCTIONS; REDUCTIONS; AND NONPAYMENTS OF BENEFITS
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| Deduction, reduction, and nonpayment of monthly benefits or lump-sum death payments. |
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| When we do not pay benefits because of a disability beneficiary's work activity. |
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| Interrelationship of deductions, reductions, adjustments, and nonpayment of benefits. |
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| Reduction where total monthly benefits exceed maximum family benefits payable. |
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| How reduction for maximum affects insured individual and other persons entitled on his earnings record. |
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| Situations where total benefits can exceed maximum because of “savings clause.” |
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| Reduction for maximum because of retroactive effect of application for monthly benefits. |
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| Reduction because of entitlement to other benefits. |
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| Reduction of benefits based on disability on account of receipt of certain other disability benefits provided under Federal, State, or local laws or plans. |
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| Reduction where spouse is receiving a Government pension. |
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| Reduction of retroactive monthly social security benefits where supplemental security income (SSI) payments were received for the same period. |
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| What is full retirement age? |
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| How does SSA reduce my benefits when my entitlement begins before full retirement age? |
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| How are benefits reduced for age when a person is entitled to two or more benefits? |
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| After my benefits are reduced for age when and how will adjustments to that reduction be made? |
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| After my benefits are reduced for age what happens if there is an increase in my primary insurance amount? |
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| Deductions because of excess earnings. |
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| Deductions because of noncovered remunerative activity outside the United States; 45 hour and 7-day work test. |
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| “Noncovered remunerative activity outside the United States,” defined. |
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| Persons deemed entitled to benefits based on an individual's earnings record. |
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| How are deductions made when a beneficiary fails to have a child in his or her care? |
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| Manner of making deductions. |
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| Total amount of deductions where more than one deduction event occurs in a month. |
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| Total amount of deductions where deduction events occur in more than 1 month. |
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| Earnings in a taxable year. |
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| Monthly and annual exempt amounts defined; excess earnings defined. |
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| Excess earnings; method of charging. |
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| Excess earnings; months to which excess earnings can or cannot be charged; grace year defined. |
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| Excess earnings; months to which excess earnings cannot be charged because individual is deemed not entitled to benefits. |
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| Excess earnings; benefit rate subject to deductions because of excess earnings. |
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| Partial monthly benefits; excess earnings of the individual charged against his benefits and the benefits of persons entitled (or deemed entitled) to benefits on his earnings record. |
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| Partial monthly benefits; pro-rated share of partial payment exceeds the benefit before deduction for excess earnings. |
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| Partial monthly benefits; insured individual and another person entitled (or deemed entitled) on the same earnings record both have excess earnings. |
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| Definition of “substantial services” and “services.” |
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| Evaluation of factors involved in substantial services test. |
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| Required reports of work outside the United States or failure to have care of a child. |
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| Penalty deductions for failure to report within prescribed time limit noncovered remunerative activity outside the United States or not having care of a child. |
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| Reports to Social Security Administration of earnings; wages; net earnings from self-employment. |
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| Penalty deductions for failure to report earnings timely. |
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| Good cause for failure to make required reports. |
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| Request by Social Security Administration for reports of earnings and estimated earnings; effect of failure to comply with request. |
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| Current suspension of benefits because an individual works or engages in self-employment. |
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| Deductions where taxes neither deducted from wages of certain maritime employees nor paid. |
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| Limiting deductions where total family benefits payable would not be affected or would be only partly affected. |
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| Penalty for making false or misleading statements or withholding information. |
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| Nonpayment of monthly benefits to aliens outside the United States. |
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| Nonpayment of lump sum after death of alien outside United States for more than 6 months. |
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| Nonpayment of hospital and medical insurance benefits of alien outside United States for more than 6 months. |
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| Nonpayment of benefits of aliens outside the United States; “foreign social insurance system,” and “treaty obligation” exceptions defined. |
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| How does deportation or removal from the United States affect the receipt of benefits? |
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| Conviction for subversive activities; effect on monthly benefits and entitlement to hospital insurance benefits. |
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| Conviction for subversive activities; effect on enrollment for supplementary medical insurance benefits. |
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| Nonpayment of benefits; individual entitled to disability insurance benefits or childhood disability benefits based on statutory blindness is engaging in substantial gainful activity. |
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| Nonpayment of benefits to prisoners. |
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| Nonpayment of benefits where individual has not furnished or applied for a Social Security number. |
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| Nonpayment of disability benefits due to noncompliance with rules regarding treatment for drug addiction or alcoholism. |
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| Nonpayment of disability benefits for trial work period service months upon a conviction of fraudulently concealing work activity. |
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| Paying benefits in installments: Drug addiction or alcoholism. |
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Subpart F—OVERPAYMENTS, UNDERPAYMENTS, WAIVER OF ADJUSTMENT OR RECOVERY OF OVERPAYMENTS, AND LIABILITY OF A CERTIFYING OFFICER
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| General applicability of section 204 of the Act. |
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| Notice of right to waiver consideration. |
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| Relation to provisions for reductions and increases. |
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| Relationship to provisions requiring deductions. |
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| When waiver may be applied and how to process the request. |
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| Defeat the purpose of Title II. |
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| Against equity and good conscience; defined. |
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| When an individual is “without fault” in a deduction overpayment. |
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| When an individual is “without fault” in an entitlement overpayment. |
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| When an individual is at “fault” in a deduction overpayment. |
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| When adjustment or recovery of an overpayment will be waived. |
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| Liability of a certifying officer. |
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| Collection and compromise of claims for overpayment. |
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| Referral of overpayments to the Department of the Treasury for tax refund offset—General. |
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| Notice to overpaid persons. |
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| Review within SSA that an overpayment is past due and legally enforceable. |
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| Review of our records related to the overpayment. |
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| Tax refund insufficient to cover amount of overpayment. |
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| Additional methods for recovery of title II benefit overpayments. |
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| Are title VIII and title XVI benefits subject to adjustment to recover title II overpayments? |
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| How much will we withhold from your title VIII and title XVI benefits to recover a title II overpayment? |
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| Will you receive notice of our intention to apply cross-program recovery? |
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| When will we begin cross-program recovery from current monthly benefits? |
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Subpart G—FILING OF APPLICATIONS AND OTHER FORMS
General Provisions
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| You must file an application to receive benefits. |
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Applications
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| What makes an application a claim for benefits? |
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| How do I file an application for Social Security benefits? |
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| Who may sign an application. |
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| Evidence of authority to sign an application for another. |
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| When an application or other form is considered filed. |
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| Claimant must be alive when an application is filed. |
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| Pilot program for photographic identification of disability benefit applicants in designated geographic areas. |
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Effective Filing Period of Application
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| Filing before the first month you meet the requirements for benefits. |
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| What happens if I file after the first month I meet the requirements for benefits? |
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| Am I required to file for all benefits if I am eligible for old-age and husband's or wife's benefits? |
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Filing Date Based on Written Statement
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| Use of date of written statement as filing date. |
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| Statements filed with the Railroad Retirement Board. |
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| Statements filed with a hospital. |
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Deemed Filing Date Based on Misinformation
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| Deemed filing date in a case of misinformation. |
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Withdrawal of Application
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| Withdrawal of an application. |
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| Cancellation of a request to withdraw. |
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Subpart H—EVIDENCE
General
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| Your responsibility for giving evidence. |
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| Failure to give requested evidence. |
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| Original records or copies as evidence. |
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| How we decide what is enough evidence. |
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| Preferred evidence and other evidence. |
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Evidence of Age, Marriage, and Death
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| When evidence of age is needed. |
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| Type of evidence of age to be given. |
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| Evidence of a person's death. |
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| Evidence to presume a person is dead. |
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| Rebuttal of a presumption of death. |
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| When evidence of marriage is required. |
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| Evidence of a valid ceremonial marriage. |
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| Evidence of common-law marriage. |
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| Evidence of a deemed valid marriage. |
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| Evidence a marriage has ended. |
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Evidence for Child's and Parent's Benefits
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| When evidence of a parent or child relationship is needed. |
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| Evidence you are a natural parent or child. |
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| Evidence you are a stepparent or stepchild. |
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| Evidence you are the legally adopting parent or legally adopted child. |
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| Evidence you are an equitably adopted child. |
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| Evidence you are the grandchild or stepgrandchild. |
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| Evidence of a child's dependency. |
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| Evidence of school attendance for child age 18 or older. |
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| Evidence of a parent's support. |
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Other Evidence Requirements
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| Evidence of living in the same household with insured person. |
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| What is acceptable evidence of having a child in my care? |
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| Evidence of where the insured person had a permanent home. |
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| Evidence of “good cause” for exceeding time limits on accepting proof of support or application for a lump-sum death payment. |
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Subpart I—RECORDS OF EARNINGS
General Provisions
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| Conclusiveness of the record of your earnings. |
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Obtaining Earnings Information
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| How to obtain a statement of earnings and a benefit estimate statement. |
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| The statement of earnings and benefit estimates you requested. |
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| Statement of earnings and benefit estimates sent without request. |
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Correcting the Earnings Record
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| Filing a request for correction of the record of your earnings. |
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| Correction of the record of your earnings before the time limit ends. |
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| Correction of the record of your earnings after the time limit ends. |
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| Correction of the record of your earnings for work in the employ of the United States. |
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Notice of Removal or Reduction of an Entry of Earnings
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| Notice of removal or reduction of your wages. |
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| Notice of removal or reduction of your self-employment income. |
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Subpart J—DETERMINATIONS, ADMINISTRATIVE REVIEW PROCESS, AND REOPENING OF DETERMINATIONS AND DECISIONS
Introduction, Definitions, and Initial Determinations
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| Administrative actions that are initial determinations. |
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| Administrative actions that are not initial determinations. |
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| Notice of the initial determination. |
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| Effect of an initial determination. |
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| Testing modifications to the disability determination procedures. |
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Reconsideration
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| Parties to a reconsideration. |
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| How to request reconsideration. |
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| Good cause for missing the deadline to request review. |
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| Reconsideration procedures. |
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| Disability hearing—general. |
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| Disability hearing—disability hearing officers. |
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| Disability hearing—procedures. |
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| Disability hearing—disability hearing officer's reconsidered determination. |
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| Disability hearing—review of the disability hearing officer's reconsidered determination before it is issued. |
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| Notice of another person's request for reconsideration. |
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| Reconsidered determination. |
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| Effect of a reconsidered determination. |
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| Notice of a reconsidered determination. |
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Expedited Appeals Process
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| Expedited appeals process—general. |
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| When the expedited appeals process may be used. |
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| How to request expedited appeals process. |
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| Agreement in expedited appeals process. |
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| Effect of expedited appeals process agreement. |
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| Expedited appeals process request that does not result in agreement. |
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Hearing Before an Administrative Law Judge
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| Hearing before an administrative law judge—general. |
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| Availability of a hearing before an administrative law judge. |
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| Parties to a hearing before an administrative law judge. |
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| How to request a hearing before an administrative law judge. |
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| Submitting written evidence to an administrative law judge. |
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| Time and place for a hearing before an administrative law judge. |
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| Protecting the safety of the public and our employees in our hearing process. |
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| Notice of a hearing before an administrative law judge. |
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| Objections to the issues. |
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| Disqualification of the administrative law judge. |
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| Prehearing proceedings and decisions by attorney advisors. |
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| Responsibilities of the adjudication officer. |
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Administrative Law Judge Hearing Procedures
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| Administrative law judge hearing procedures—general. |
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| Issues before an administrative law judge. |
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| Deciding a case without an oral hearing before an administrative law judge. |
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| Presenting written statements and oral arguments. |
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| Presenting evidence at a hearing before an administrative law judge. |
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| Consolidated hearing before an administrative law judge. |
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| The decision of an administrative law judge. |
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| The effect of an administrative law judge's decision. |
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| Removal of a hearing request from an administrative law judge to the Appeals Council. |
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| Dismissal of a request for a hearing before an administrative law judge. |
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| Notice of dismissal of a request for a hearing before an administrative law judge. |
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| Effect of dismissal of a request for a hearing before an administrative law judge. |
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| Vacating a dismissal of a request for a hearing before an administrative law judge. |
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| Prehearing and posthearing conferences. |
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Appeals Council Review
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| Testing elimination of the request for Appeals Council review. |
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| Appeals Council review—general. |
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| How to request Appeals Council review. |
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| Appeals Council initiates review. |
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| Cases the Appeals Council will review. |
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| Dismissal by Appeals Council. |
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| Effect of dismissal of request for Appeals Council review. |
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| Notice of Appeals Council review. |
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| Obtaining evidence from Appeals Council. |
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| Filing briefs with the Appeals Council. |
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| Procedures before the Appeals Council on review. |
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| Case remanded by Appeals Council. |
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| Decision of Appeals Council. |
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| Effect of Appeals Council's decision or denial of review. |
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| Extension of time to file action in Federal district court. |
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Court Remand Cases
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| Case remanded by a Federal court. |
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| Appeals Council review of administrative law judge decision in a case remanded by a Federal court. |
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| Application of circuit court law. |
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Reopening and Revising Determinations and Decisions
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| Reopening and revising determinations and decisions. |
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| Conditions for reopening. |
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| Good cause for reopening. |
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| Finality of determinations and decisions on revision of an earnings record. |
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| Finality of determinations and decisions to suspend benefit payments for entire taxable year because of earnings. |
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| Late completion of timely investigation. |
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| Notice of revised determination or decision. |
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| Effect of revised determination or decision. |
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| Time and place to request a hearing on revised determination or decision. |
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| Finality of findings when later claim is filed on same earnings record. |
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| Increase in future benefits where time period for reopening expires. |
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Payment of Certain Travel Expenses
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| Payment of certain travel expenses—general. |
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| What travel expenses are reimbursable. |
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| When and how to claim reimbursement. |
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Subpart K—EMPLOYMENT, WAGES, SELF-EMPLOYMENT, AND SELF-EMPLOYMENT INCOME
Employment
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| What work is covered as employment? |
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| Agent-driver or commission-driver, full-time life insurance salesman, home worker, or traveling or city salesman. |
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| Farm crew leader as employer. |
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Work Excluded From Employment
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| Work excluded from employment. |
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| Domestic service by a student for a local college club, fraternity or sorority. |
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| Foreign agricultural workers. |
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| Work by civilians for the United States Government or its instrumentalities—wages paid after 1983. |
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| Work by civilians for the United States Government or its instrumentalities—remuneration paid prior to 1984. |
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| Medicare qualified government employment. |
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| Work as a member of a uniformed service of the United States. |
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| Work for States and their political subdivisions and instrumentalities. |
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| Work for the District of Columbia. |
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| American Samoa, Guam, or the Commonwealth of the Northern Mariana Islands. |
|
|
| Ministers of churches and members of religious orders. |
|
|
| Election of coverage by religious orders. |
|
|
| Work for religious, charitable, educational, or certain other organizations exempt from income tax. |
|
|
| Work for a church or qualified church-controlled organization. |
|
|
| Student working for a school, college, or university. |
|
|
| Delivery and distribution or sale of newspapers, shopping news, and magazines. |
|
|
| Work for a foreign government. |
|
|
| Work for a wholly owned instrumentality of a foreign government. |
|
|
| Work for an international organization. |
|
|
| Work for a communist organization. |
|
|
| Certain nonresident aliens. |
|
|
| Work on or in connection with a non-American vessel or aircraft. |
|
|
| Domestic employees under age 18. |
|
Exemption From Social Security by Reason of Religious Belief
|
| Employers (including partnerships) and employees who are both members of certain religious groups opposed to insurance. |
|
Wages
|
| Wages when paid and received. |
|
|
| Facilities or privileges—meals and lodging. |
|
|
| Pay for work by certain members of religious orders. |
|
|
| Contribution and benefit base after 1992. |
|
|
| Payments under an employer plan or system. |
|
|
| Payments on account of sickness or accident disability, or related medical or hospitalization expenses. |
|
|
| Payments from or to certain tax-exempt trusts or payments under or into certain annuity plans. |
|
|
| “Qualified benefits” under a cafeteria plan. |
|
|
| Payments by an employer of employee's tax or employee's contribution under State law. |
|
|
| Payments for agricultural labor. |
|
|
| Explanation of agricultural labor. |
|
|
| Domestic service in the employer's home. |
|
|
| Deemed wages for certain individuals interned during World War II. |
|
Self-Employment
|
| Self-employment coverage. |
|
|
| Trade or business in general. |
|
|
| Employees who are considered self-employed. |
|
|
| Real estate agents and direct sellers. |
|
|
| Christian Science practitioners. |
|
|
| Ministers and members of religious orders. |
|
|
| Farm crew leader who is self-employed. |
|
|
| Members of certain religious groups opposed to insurance. |
|
|
| Individuals under railroad retirement system. |
|
Self-Employment Income
|
| Net earnings from self-employment. |
|
|
| General rules for figuring net earnings from self-employment. |
|
|
| Rentals from real estate; material participation. |
|
|
| Gain or loss from disposition of property; capital assets; timber, coal, and iron ore; involuntary conversion. |
|
|
| Net operating loss deduction. |
|
|
| Figuring partner's net earnings from self-employment for taxable year which ends as a result of death. |
|
|
| Retirement payment to retired partners. |
|
|
| Figuring net earnings for residents and nonresidents of Puerto Rico. |
|
|
| Personal exemption deduction. |
|
|
| Figuring net earnings for ministers and members of religious orders. |
|
|
| Figuring net earnings for U.S. citizens or residents living outside the United States. |
|
|
| Possession of the United States. |
|
|
| Options available for figuring net earnings from self-employment. |
|
|
| Agricultural trade or business. |
|
Subpart L—[RESERVED]
Subpart M—COVERAGE OF EMPLOYEES OF STATE AND LOCAL GOVERNMENTS
General
|
| Scope of this subpart regarding coverage and wage reports and adjustments. |
|
|
| Evidence—for wages paid prior to 1987. |
|
|
| Designating officials to act on behalf of the State. |
|
What Groups of Employees May Be Covered
|
| Absolute coverage groups. |
|
|
| Retirement system coverage groups. |
|
|
| Divided retirement system coverage groups. |
|
|
| Mandatorily excluded services. |
|
|
| Optionally excluded services. |
|
|
| Interstate instrumentalities. |
|
|
| Police officers and firefighters. |
|
How Coverage Under Agreements Is Obtained and Continues
|
| Modification of agreement. |
|
|
| Modification of agreement to correct an error. |
|
|
| Continuation of coverage. |
|
|
| Dissolution of political subdivision. |
|
How To Identify Covered Employees
What Records of Coverage Must Be Kept
|
| Records—for wages paid prior to 1987. |
|
Review of Compliance by State With Its Agreement
|
| Reports of review's findings. |
|
How To Report Wages and Contributions—for Wages Paid Prior to 1987
|
| Wage reports and contribution returns—general—for wages paid prior to 1987. |
|
|
| Wage reports for employees performing services in more than one coverage group—for wages paid prior to 1987. |
|
|
| Use of reporting forms—for wages paid prior to 1987. |
|
|
| When to report wages—for wages paid prior to 1987. |
|
|
| When and where to make deposits of contributions and to file contribution returns and wage reports—for wages paid prior to 1987. |
|
|
| Final reports—for wages paid prior to 1987. |
|
What Is a State's Liability for Contributions—for Wages Paid Prior to 1987
|
| State's liability for contributions—for wages paid prior to 1987. |
|
|
| Limitation on State's liability for contributions for multiple employment situations—for wages paid prior to 1987. |
|
Figuring the Amount of the State's Contributions—for Wages Paid Prior to 1987
|
| Amount of contributions—for wages paid prior to 1987. |
|
|
| Manner of payment of contributions by State—for wages paid prior to 1987. |
|
|
| When fractional part of a cent may be disregarded—for wages paid prior to 1987. |
|
If a State Fails To Make Timely Payments—for Wages Paid Prior to 1987
|
| Addition of interest to contributions—for wages paid prior to 1987. |
|
|
| Failure to make timely payments—for wages paid prior to 1987. |
|
How Errors in Reports and Contributions Are Adjusted—for Wages Paid Prior to 1987
|
| Adjustments in general—for wages paid prior to 1987. |
|
|
| Adjustment of overpayment of contributions—for wages paid prior to 1987. |
|
|
| Refund or recomputation of overpayments which are not adjustable—for wages paid prior to 1987. |
|
|
| Adjustment of employee contributions—for wages paid prior to 1987. |
|
|
| Reports and payments erroneously made to Internal Revenue Service-transfer of funds—for wages paid prior to 1987. |
|
How Overpayments of Contributions Are Credited or Refunded—for Wages Paid Prior to 1987
|
| Allowance of credits or refunds—for wages paid prior to 1987. |
|
|
| Credits or refunds for periods of time during which no liability exists—for wages paid prior to 1987. |
|
|
| Time limitations on credits or refunds—for wages paid prior to 1987. |
|
|
| Exceptions to the time limitations on credits or refunds—for wages paid prior to 1987. |
|
|
| Offsetting underpayments against overpayments—for wages paid prior to 1987. |
|
How Assessments for Underpayments of Contributions Are Made—for Wages Paid Prior to 1987
|
| Assessments of amounts due—for wages paid prior to 1987. |
|
|
| Time limitations on assessments—for wages paid prior to 1987. |
|
|
| Exceptions to the time limitations on assessments—for wages paid prior to 1987. |
|
|
| Payment after expiration of time limitation for assessment—for wages paid prior to 1987. |
|
Secretary's Review of Decisions on Credits, Refunds, or Assessments—for Wages Paid Prior to 1987
|
| Review of decisions by the Secretary—for wages paid prior to 1987. |
|
|
| Reconsideration—for wages paid prior to 1987. |
|
|
| How to request review—for wages paid prior to 1987. |
|
|
| Time for filing request for review—for wages paid prior to 1987. |
|
|
| Notification to State after reconsideration—for wages paid prior to 1987. |
|
|
| Commissioner's review—for wages paid prior to 1987. |
|
|
| Commissioner's notification to the State—for wages paid prior to 1987. |
|
How a State May Seek Court Review of Commissioner's Decision—for Wages Paid Prior to 1987
|
| Review by court—for wages paid prior to 1987. |
|
|
| Time for filing civil action—for wages paid prior to 1987. |
|
|
| Final judgments—for wages paid prior to 1987. |
|
Subpart N—WAGE CREDITS FOR VETERANS AND MEMBERS OF THE UNIFORMED SERVICES
General
World War II Veterans
|
| Who is a World War II veteran. |
|
|
| Ninety-day active service requirement for World War II veterans. |
|
|
| World War II service included. |
|
|
| World War II service excluded. |
|
Post-World War II Veterans
|
| Who is a post-World War II veteran. |
|
|
| Ninety-day active service requirement for post-World War II veterans. |
|
|
| Post-World War II service included. |
|
|
| Post-World War II service excluded. |
|
Separation from Active Service
|
| Separation from active service under conditions other than dishonorable. |
|
Members of the Uniformed Services
|
| Who is a member of a uniformed service. |
|
Amounts of Wage Credits and Limits on Their Use
|
| Wage credits for World War II and post-World War II veterans. |
|
|
| Wage credits for a member of a uniformed service. |
|
|
| Limits on granting World War II and post-World War II wage credits. |
|
|
| When the limits on granting World War II and post-World War II wage credits do not apply. |
|
Deemed Insured Status for World II Veterans
|
| When deemed insured status does not apply. |
|
|
| Benefits and payments based on deemed insured status. |
|
Effect of Other Benefits on Payment of Social Security Benefits and Payments
|
| Veterans Administration pension or compensation payable. |
|
|
| Federal benefit payable other than by Veterans Administration. |
|
|
| Treatment of social security benefits or payments where Veterans Administration pension or compensation payable. |
|
|
| Treatment of social security benefits or payments where Federal benefit payable other than by Veterans Administration. |
|
Evidence of Active Service and Membership in a Uniformed Service
|
| Evidence of active service and separation from active service. |
|
|
| Evidence of membership in a uniformed service during the years 1957 through 1967. |
|
Subpart O—INTERRELATIONSHIP OF OLD-AGE, SURVIVORS AND DISABILITY INSURANCE PROGRAM WITH THE RAILROAD RETIREMENT PROGRAM
|
| What is the interrelationship between the Railroad Retirement Act and the Old-Age, Survivors and Disability Insurance Program of the Social Security Act? |
|
|
| When are railroad industry services by a non-vested worker covered under Social Security? |
|
|
| Effective date of coverage of railroad services under the act. |
|
|
| If you have been considered a non-vested worker, what are the situations when your railroad industry work will not be covered under Social Security? |
|
|
| Eligibility to railroad retirement benefits as a bar to payment of social security benefits. |
|
|
| When railroad retirement benefits do not bar payment of social security benefits. |
|
|
| Compensation to be treated as wages. |
|
|
| Purposes of using compensation. |
|
|
| Presumption on basis of certified compensation record. |
|
|
| Compensation quarters of coverage. |
|
|
| When will we certify payment to the Railroad Retirement Board (RRB)? |
|
Subpart P—DETERMINING DISABILITY AND BLINDNESS
General
|
| Definitions for this subpart. |
|
Determinations
|
| Who makes disability and blindness determinations. |
|
|
| Evidence from excluded medical sources of evidence. |
|
|
| Decisions by other governmental agencies and nongovernmental entities. |
|
Definition of Disability
|
| Basic definition of disability. |
|
|
| When we will not consider your impairment. |
|
|
| How long the impairment must last. |
|
|
| Meaning of substantial gainful activity. |
|
|
| Definition of a disabling impairment. |
|
Evidence
|
| Responsibility for evidence. |
|
|
| Evidence from our Federal or State agency medical or psychological consultants. |
|
|
| When we will purchase existing evidence. |
|
|
| Where and how to submit evidence. |
|
|
| If you fail to submit medical and other evidence. |
|
|
| Consultative examination at our expense. |
|
|
| If you do not appear at a consultative examination. |
|
Standards To Be Used in Determining When a Consultative Examination Will Be Obtained in Connection With Disability Determinations
|
| The consultative examination. |
|
|
| When we will purchase a consultative examination and how we will use it. |
|
|
| When we will not purchase a consultative examination. |
|
Standards for the Type of Referral and for Report Content
|
| Type of purchased examinations. |
|
|
| Who we will select to perform a consultative examination. |
|
|
| Other sources for consultative examinations. |
|
|
| Objections to the medical source designated to perform the consultative examination. |
|
|
| Purchase of medical examinations, laboratory tests, and other services. |
|
|
| Diagnostic tests or procedures. |
|
|
| Informing the medical source of examination scheduling, report content, and signature requirements. |
|
|
| When a properly signed consultative examination report has not been received. |
|
|
| Reviewing reports of consultative examinations. |
|
Authorizing and Monitoring the Referral Process
|
| Authorizing and monitoring the consultative examination. |
|
Procedures To Monitor the Consultative Examination
|
| Consultative examination oversight. |
|
Evaluation of Disability
|
| Evaluation of disability in general. |
|
|
| Evaluation of mental impairments. |
|
|
| How we consider evidence. |
|
|
| How we consider and articulate medical opinions and prior administrative medical findings for claims filed on or after March 27, 2017. |
|
|
| Establishing that you have a medically determinable impairment(s). |
|
|
| What we mean by an impairment(s) that is not severe. |
|
Medical Considerations
|
| Listing of Impairments in appendix 1. |
|
|
| Evaluating opinion evidence for claims filed before March 27, 2017. |
|
|
| How we evaluate symptoms, including pain. |
|
|
| Need to follow prescribed treatment. |
|
|
| How we will determine whether your drug addiction or alcoholism is a contributing factor material to the determination of disability. |
|
|
| Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability. |
|
|
| What we mean by appropriate treatment. |
|
|
| What we mean by approved institutions or facilities. |
|
|
| How we consider whether treatment is available. |
|
|
| Evaluating compliance with the treatment requirements. |
|
|
| Establishment and use of referral and monitoring agencies. |
|
Residual Functional Capacity
|
| Your residual functional capacity. |
|
|
| Responsibility for assessing your residual functional capacity. |
|
Vocational Considerations
|
| When we will consider your vocational background. |
|
|
| Medical-vocational profiles showing an inability to make an adjustment to other work. |
|
|
| Your age as a vocational factor. |
|
|
| Your education as a vocational factor. |
|
|
| Your work experience as a vocational factor. |
|
|
| Work which exists in the national economy. |
|
|
| Physical exertion requirements. |
|
|
| Listing of Medical-Vocational Guidelines in appendix 2. |
|
|
| Exertional and nonexertional limitations. |
|
Substantial Gainful Activity
|
| What we mean by substantial gainful activity. |
|
|
| General information about work activity. |
|
|
| Evaluation guides if you are an employee. |
|
|
| When and how we will average your earnings. |
|
|
| Evaluation guides if you are self-employed. |
|
|
| Impairment-related work expenses. |
|
Widows, Widowers, and Surviving Divorced Spouses
|
| Disability defined for widows, widowers, and surviving divorced spouses for monthly benefits payable for months prior to January 1991. |
|
|
| How we determine disability for widows, widowers, and surviving divorced spouses for monthly benefits payable for months prior to January 1991. |
|
|
| How we will determine whether your disability continues or ends. |
|
Blindness
|
| Meaning of blindness as defined in the law. |
|
|
| A period of disability based on blindness. |
|
|
| How we determine disability for blind persons who are age 55 or older. |
|
|
| Evaluation of work activity of blind people. |
|
|
| Trial work period for persons age 55 or older who are blind. |
|
|
| Why and when we will stop your cash benefits. |
|
|
| Circumstances under which we may suspend and terminate your benefits before we make a determination. |
|
Continuing or Stopping Disability
|
| Your responsibility to tell us of events that may change your disability status. |
|
|
| We may conduct a review to find out whether you continue to be disabled. |
|
|
| When and how often we will conduct a continuing disability review. |
|
|
| If your medical recovery was expected and you returned to work. |
|
|
| The reentitlement period. |
|
|
| What is expedited reinstatement? |
|
|
| Who is entitled to expedited reinstatement? |
|
|
| How do I request reinstatement? |
|
|
| How do we determine provisional benefits? |
|
|
| How do we determine reinstated benefits? |
|
|
| Medical evidence in continuing disability review cases. |
|
|
| How we will determine whether your disability continues or ends. |
|
|
| When we determine that you are not now disabled. |
|
|
| Circumstances under which we may suspend and terminate your benefits before we make a determination. |
|
|
| After we make a determination that you are not now disabled. |
|
|
| Continued benefits pending appeal of a medical cessation determination. |
|
|
| If you become disabled by another impairment(s). |
|
|
| Work incentive experiments and rehabilitation demonstration projects in the disability program. |
|
Subpart Q—DETERMINATIONS OF DISABILITY
General Provisions
|
| Basic responsibilities for us and the State. |
|
Responsibilities for Performing the Disability Determination Function
|
| How a State notifies us that it wishes to perform the disability determination function. |
|
|
| How we notify a State whether it may perform the disability determination function. |
|
|
| Disability determinations the State makes. |
|
|
| Responsibilities for obtaining evidence to make disability determinations. |
|
|
| Making disability determinations. |
|
|
| Medical consultants and psychological consultants. |
|
|
| Reasonable efforts to obtain review by a physician, psychiatrist, and psychologist. |
|
|
| Notifying claimants of the disability determination. |
|
Quick Disability Determinations
|
| Quick disability determination process. |
|
Administrative Responsibilities and Requirements
|
| General administrative requirements. |
|
|
| Medical and other purchased services. |
|
|
| Participation in research and demonstration projects. |
|
|
| Coordination with other agencies. |
|
|
| Confidentiality of information and records. |
|
|
| Other Federal laws and regulations. |
|
|
| Policies and operating instructions. |
|
Performance Standards
|
| Standards of performance. |
|
|
| Processing time standards. |
|
|
| Performance accuracy standard. |
|
|
| How and when we determine whether the processing time standards are met. |
|
|
| How and when we determine whether the performance accuracy standard is met. |
|
|
| Action we will take if a State agency does not meet the standards. |
|
Performance Monitoring and Support
|
| When we will provide performance support. |
|
|
| What support we will provide. |
|
Substantial Failure
|
| Good cause for not following the Act, our regulations, or other written guidelines. |
|
|
| Finding of substantial failure. |
|
Hearings and Appeals
|
| Notice of right to hearing on proposed finding of substantial failure. |
|
|
| Disputes on matters other than substantial failure. |
|
|
| Who conducts the hearings. |
|
|
| Hearings and appeals process. |
|
Assumption of Disability Determination Function
|
| Assumption when we make a finding of substantial failure. |
|
|
| Assumption when State no longer wishes to perform the disability determination function. |
|
|
| Protection of State employees. |
|
|
| Limitation on State expenditures after notice. |
|
|
| Final accounting by the State. |
|
Subpart R—REPRESENTATION OF PARTIES
|
| Who may be your representative. |
|
|
| Notification of options for obtaining attorney representation. |
|
|
| Appointing a representative. |
|
|
| Authority of a representative. |
|
|
| Mandatory use of electronic services. |
|
|
| Notice or request to a representative. |
|
|
| Direct payment of fees to eligible non-attorney representatives. |
|
|
| Fee for a representative's services. |
|
|
| Request for approval of a fee. |
|
|
| Proceedings before a State or Federal court. |
|
|
| Rules of conduct and standards of responsibility for representatives. |
|
|
| Violations of our requirements, rules, or standards. |
|
|
| Notice of charges against a representative. |
|
|
| Withdrawing charges against a representative. |
|
|
| Decision by hearing officer. |
|
|
| Requesting review of the hearing officer's decision. |
|
|
| Assignment of request for review of the hearing officer's decision. |
|
|
| Appeals Council's review of hearing officer's decision. |
|
|
| Evidence permitted on review. |
|
|
| Appeals Council's decision. |
|
|
| When the Appeals Council will dismiss a request for review. |
|
|
| Reinstatement after suspension—period of suspension expired. |
|
|
| Reinstatement after suspension or disqualification—period of suspension not expired. |
|
Subpart S—PAYMENT PROCEDURES
|
| Expediting benefit payments. |
|
|
| Withholding certification or payments. |
|
|
| Transfer or assignment of payments. |
|
|
| Garnishment of payments after disbursement. |
|
|
| Joint payments to a family. |
|
Subpart T—TOTALIZATION AGREEMENTS
General Provisions
|
| Negotiating totalization agreements. |
|
|
| Effective date of a totalization agreement. |
|
|
| Termination of agreements. |
|
Benefit Provisions
|
| Crediting foreign periods of coverage. |
|
|
| Person qualifies under more than one totalization agreement. |
|
|
| Effects of a totalization agreement on entitlement to hospital insurance benefits. |
|
Coverage Provisions
|
| Precluding dual coverage. |
|
|
| Payment of contributions. |
|
Computation Provisions
|
| How benefits are computed. |
|
|
| How benefits are recomputed. |
|
|
| Supplementing the U.S. benefit if the total amount of the combined benefits is less than the U.S. minimum benefit. |
|
|
| Benefits of less than $1 due. |
|
Other Provisions
|
| Effect of the alien non-payment provision. |
|
|
| Disclosure of information. |
|
Subpart U—REPRESENTATIVE PAYMENT
|
| When payment will be made to a representative payee. |
|
|
| What happens to your monthly benefits while we are finding a suitable representative payee for you? |
|
|
| Information considered in determining whether to make representative payments. |
|
|
| Information considered in selecting a representative payee. |
|
|
| What is our order of preference in selecting a representative payee for you? |
|
|
| Who may not serve as a representative payee? |
|
|
| How do we investigate a representative payee applicant? |
|
|
| What information must a representative payee report to us? |
|
|
| How do we investigate an appointed representative payee? |
|
|
| How will we notify you when we decide you need a representative payee? |
|
|
| What are the responsibilities of your representative payee? |
|
|
| Compensation for qualified organizations serving as representative payees. |
|
|
| Who is liable if your representative payee misuses your benefits? |
|
|
| Conservation and investment of benefit payments. |
|
|
| When will we select a new representative payee for you? |
|
|
| When representative payment will be stopped. |
|
|
| Transfer of accumulated benefit payments. |
|
|
| How does your representative payee account for the use of benefits? |
|
Subpart V—PAYMENTS FOR VOCATIONAL REHABILITATION SERVICES
General Provisions
|
| Participation by State VR agencies. |
|
Payment Provisions
|
| Requirements for payment. |
|
|
| Responsibility for making payment decisions. |
|
|
| What we mean by “SGA” and by “a continuous period of 9 months”. |
|
|
| Criteria for determining when VR services will be considered to have contributed to a continuous period of 9 months. |
|
|
| Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. |
|
|
| Services for which payment may be made. |
|
|
| When services must have been provided. |
|
|
| When claims for payment for VR services must be made (filing deadlines). |
|
Administrative Provisions
|
| Confidentiality of information and records. |
|
|
| Other Federal laws and regulations. |
|
| 
