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Notes

20 C.F.R. §§ 404.1601–404.1603

3 sections in range

§404.1601. Purpose and scope.

20 C.F.R. § 404.1601

This subpart describes the standards of performance and administrative requirements and procedures for States making determinations of disability for the Commissioner under title II of the Act. It also establishes the Commissioner's responsibilities in carrying out the disability determination function.
(a)
Sections 404.1601 through 404.1603 describe the purpose of the regulations and the meaning of terms frequently used in the regulations. They also briefly set forth the responsibilities of the Commissioner and the States covered in detail in other sections.
(b)
Sections 404.1610 through 404.1618 describe the Commissioner's and the State's responsibilities in performing the disability determination function.
(c)
Sections 404.1620 through 404.1633 describe the administrative responsibilities and requirements of the States. The corresponding role of the Commissioner is also set out.
(d)
Sections 404.1640 through 404.1650 describe the performance accuracy and processing time standards for measuring State agency performance.
(e)
Sections 404.1660 through 404.1661 describe when and what kind of assistance the Commissioner will provide State agencies to help them improve performance.
(f)
Sections 404.1670 through 404.1675 describe the level of performance below which the Commissioner will consider a State agency to be substantially failing to make disability determinations consistent with the regulations and other written guidelines and the resulting action the Commissioner will take.
(g)
Sections 404.1680 through 404.1683 describe the rules for resolving disputes concerning fiscal issues and providing hearings when we propose to find that a State is in substantial failure.
(h)
Sections 404.1690 through 404.1694 describe when and what action the Commissioner will take and what action the State will be expected to take if the Commissioner assumes the disability determination function from a State agency.
Notes, amendments, and revision history

Amendments

[46 FR 29204, May 29, 1981, as amended at 62 FR 38451, July 18, 1997; 71 FR 16445, Mar. 31, 2006; 76 FR 24808, May 3, 2011]

Authority

Authority: Secs. 205(a), 221, and 702(a)(5) of the Social Security Act (42 U.S.C. 405(a), 421, and 902(a)(5)).

Source

Source: 46 FR 29204, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29204, May 29, 1981, as amended at 62 FR 38451, July 18, 1997; 71 FR 16445, Mar. 31, 2006; 76 FR 24808, May 3, 2011]

§404.1602. Definitions.

20 C.F.R. § 404.1602

For purposes of this subpart:

Act means the Social Security Act, as amended.

Class or classes of cases means the categories into which disability claims are divided according to their characteristics.

Commissioner means the Commissioner of Social Security or his or her authorized designee.

Compassionate allowance means a determination or decision we make under a process that identifies for expedited handling claims that involve impairments that invariably qualify under the Listing of Impairments in appendix 1 to subpart P based on minimal, but sufficient, objective medical evidence.

Determination of disability or disability determination means one or more of the following decisions:

(a)
Whether or not a person is under a disability;
(b)
The date a person's disability began; or
(c)
The date a person's disability ended. Disability means disability or blindness as defined in sections 216(i) and 223 of the Act or as defined in title IV of the Federal Mine Safety and Health Act of 1977, as amended.

Disability determination function means making determinations as to disability and carrying out related administrative and other responsibilities.

Disability program means, as appropriate, the Federal programs for providing disability insurance benefits under title II of the Act and disability benefits under title IV of the Federal Mine Safety and Health Act of 1977, as amended.

Initial means the first level of disability adjudication.

Other written guidelines means written issuances such as Social Security Rulings and memoranda by the Commissioner of Social Security, the Deputy Commissioner for Programs and Policy, or the Associate Commissioner for Disability and the procedures, guides, and operating instructions in the Disability Insurance sections of the Program Operations Manual System, that are instructive, interpretive, clarifying, and/or administrative and not designated as advisory or discretionary. The purpose of including the foregoing material in the definition is to assure uniform national application of program standards and service delivery to the public.

Quick disability determination means an initial determination on a claim that we have identified as one that reflects a high degree of probability that you will be found disabled and where we expect that your allegations will be easily and quickly verified.

Regulations means regulations in this subpart issued under sections 205(a), 221 and 1102 of the Act, unless otherwise indicated.

State means any of the 50 States of the United States, the Commonwealth of Puerto Rico, the District of Columbia, or Guam. It includes the State agency.

State agency means that agency of a State which has been designated by the State to carry out the disability determination function.

We, us, and our refers to the Social Security Administration (SSA).

Notes, amendments, and revision history

Amendments

[46 FR 29204, May 29, 1981, as amended at 56 FR 11018, Mar. 14, 1991; 62 FR 38452, July 18, 1997; 72 FR 51177, Sept. 6, 2007; 75 FR 62682, Oct. 13, 2010]

Authority

Authority: Secs. 205(a), 221, and 702(a)(5) of the Social Security Act (42 U.S.C. 405(a), 421, and 902(a)(5)).

Source

Source: 46 FR 29204, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29204, May 29, 1981, as amended at 56 FR 11018, Mar. 14, 1991; 62 FR 38452, July 18, 1997; 72 FR 51177, Sept. 6, 2007; 75 FR 62682, Oct. 13, 2010]

§404.1603. Basic responsibilities for us and the State.

20 C.F.R. § 404.1603

(a)
General. We will work with the State to provide and maintain an effective system for processing claims of those who apply for and who are receiving benefits under the disability program. We will provide program standards, leadership, and oversight. We do not intend to become involved in the State's ongoing management of the program except as is necessary and in accordance with these regulations. The State will comply with our regulations and other written guidelines.
(b)
Our responsibilities. We will:
(1)
Periodically review the regulations and other written guidelines to determine whether they insure effective and uniform administration of the disability program. To the extent feasible, we will consult with and take into consideration the experience of the States in issuing regulations and guidelines necessary to insure effective and uniform administration of the disability program;
(2)
Provide training materials or in some instances conduct or specify training, see § 404.1622;
(3)
Provide funds to the State agency for the necessary cost of performing the disability determination function, see § 404.1626;
(4)
Monitor and evaluate the performance of the State agency under the established standards, see §§ 404.1644 and 404.1645; and
(5)
Maintain liaison with the medical profession nationally and with national organizations and agencies whose interests or activities may affect the disability program.
(c)
Responsibilities of the State. The State will:
(1)
Provide management needed to insure that the State agency carries out the disability determination function so that disability determinations are made accurately and promptly;
(2)
Provide an organizational structure, adequate facilities, qualified personnel, medical consultant services, designated quick disability determination examiners (§§ 404.1619 and 404.1620(c)), and a quality assurance function (§§ 404.1620 through 404.1624);
(3)
Furnish reports and records relating to the administration of the disability program (§ 404.1625);
(4)
Submit budgets (§ 404.1626);
(5)
Cooperate with audits (§ 404.1627);
(6)
Insure that all applicants for and recipients of disability benefits are treated equally and courteously;
(7)
Be responsible for property used for disability program purposes (§ 404.1628);
(8)
Take part in the research and demonstration projects (§ 404.1629);
(9)
Coordinate with other agencies (§ 404.1630);
(10)
Safeguard the records created by the State in performing the disability determination function (§ 404.1631);
(11)
Comply with other provisions of the Federal law and regulations that apply to the State in performing the disability determination function;
(12)
Comply with other written guidelines (§ 404.1633);
(13)
Maintain liaison with the medical profession and organizations that may facilitate performing the disability determination function; and
(14)
Assist us in other ways that we determine may promote the objectives of effective and uniform administration.
Notes, amendments, and revision history

Amendments

[46 FR 29204, May 29, 1981, as amended at 72 FR 51177, Sept. 6, 2007]

Authority

Authority: Secs. 205(a), 221, and 702(a)(5) of the Social Security Act (42 U.S.C. 405(a), 421, and 902(a)(5)).

Source

Source: 46 FR 29204, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29204, May 29, 1981, as amended at 72 FR 51177, Sept. 6, 2007]