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Notes

20 C.F.R. §§ 416.1001–416.1003

3 sections in range

§416.1001. Purpose and scope.

20 C.F.R. § 416.1001

This subpart describes the standards of performance and administrative requirements and procedures for States making determinations of disability for the Commissioner under title XVI of the Act. It also establishes the Commissioner's responsibilities in carrying out the disability determination function.
(a)
Sections 416.1001 through 416.1003 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 416.1010 through 416.1018 describe the Commissioner's and the State's responsibilities in performing the disability determination function.
(c)
Sections 416.1020 through 416.1033 describe the administrative responsibilities and requirements of the States. The corresponding role of the Commissioner is also set out.
(d)
Sections 416.1040 through 416.1050 describe the performance accuracy and processing time standards for measuring State agency performance.
(e)
Sections 416.1060 through 416.1061 describe when and what kind of assistance the Commissioner will provide State agencies to help them improve performance.
(f)
Sections 416.1070 through 416.1075 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 416.1080 through 416.1083 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 416.1090 through 416.1094 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 29211, May 29, 1981, as amended at 62 FR 38454, July 18, 1997; 71 FR 16461, Mar. 31, 2006; 76 FR 24812, May 3, 2011]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 62 FR 38454, July 18, 1997; 71 FR 16461, Mar. 31, 2006; 76 FR 24812, May 3, 2011]

§416.1002. Definitions.

20 C.F.R. § 416.1002

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 of part 404 of this chapter 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 1614(a) (2) and (3) of the Act.

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

Disability program means the Federal program for providing supplemental security income benefits for the blind and disabled under title XVI of the Act, as amended.

Initial means the first level of disability or blindness 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 1102, 1631(c) and 1633(a) of the Act, unless otherwise indicated.

State means any of the 50 States of the United States and the District of Columbia. 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 29211, May 29, 1981, as amended at 56 FR 11021, Mar. 14, 1991; 62 FR 38454, July 18, 1997; 72 FR 51178, Sept. 6, 2007; 75 FR 62683, Oct. 13, 2010]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 56 FR 11021, Mar. 14, 1991; 62 FR 38454, July 18, 1997; 72 FR 51178, Sept. 6, 2007; 75 FR 62683, Oct. 13, 2010]

§416.1003. Basic responsibilities for us and the State.

20 C.F.R. § 416.1003

(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 § 416.1022);
(3)
Provide funds to the State agency for the necessary cost of performing the disability determination function (see § 416.1026);
(4)
Monitor and evaluate the performance of the State agency under the established standards (see §§ 416.1044 and 416.1045); 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 (§§ 416.1019 and 416.1020(c)), and a quality assurance function (§§ 416.1020 through 416.1024);
(3)
Furnish reports and records relating to the administration of the disability program (§ 416.1025);
(4)
Submit budgets (§ 416.1026);
(5)
Cooperate with audits (§ 416.1027);
(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 (§ 416.1028);
(8)
Take part in the research and demonstration projects (§ 416.1029);
(9)
Coordinate with other agencies (§ 416.1030);
(10)
Safeguard the records created by the State in performing the disability determination function (§ 416.1031);
(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 (§ 416.1033);
(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 29211, May 29, 1981, as amended at 72 FR 51178, Sept. 6, 2007]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 72 FR 51178, Sept. 6, 2007]