50266 Federal Register / Vol. 62, No. 186 / Thursday, September 25, 1997 / Proposed Rules

owner/operator must request approval for an

alternative method of compliance in

accordance with paragraph (b) of this AD.

The request should include an assessment of

the effect of the modification, alteration, or

repair on the unsafe condition addressed by

this AD; and, if the unsafe condition has not

been eliminated, the request should include

specific proposed actions to address it.

Compliance: Required as indicated, unless

accomplished previously.

To prevent jamming in the rudder control

system, and consequent reduced

controllability of the airplane, accomplish

the following:

(a) Within 30 days after the effective date

of this AD, perform a one-time visual

inspection to determine if the rigging

bushings of the rudder control system

protrude above the surface of the flange in

which they are installed, in accordance with

Dornier Alert Service Bulletin ASB–328–27–

003, dated July 13, 1994. If any bushing

protrudes by any amount above the surface

of the flange, prior to further flight, replace

the bushing with a new bushing, in

accordance with the alert service bulletin.

(b) An alternative method of compliance or

adjustment of the compliance time that

provides an acceptable level of safety may be

used if approved by the Manager,

Standardization Branch, ANM–113, FAA,

Transport Airplane Directorate. Operators

shall submit their requests through an

appropriate FAA Principal Maintenance

Inspector, who may add comments and then

send it to the Manager, Standardization

Branch, ANM–113.

Note 2: Information concerning the

existence of approved alternative methods of

compliance with this AD, if any, may be

obtained from the Standardization Branch,

ANM–113.

(c) Special flight permits may be issued in

accordance with sections 21.197 and 21.199

of the Federal Aviation Regulations (14 CFR

21.197 and 21.199) to operate the airplane to

a location where the requirements of this AD

can be accomplished.

Note 3: The subject of this AD is addressed

in German airworthiness directive 96–176,

dated June 6, 1996.

Issued in Renton, Washington, on

September 19, 1997.

Vi L. Lipski,

Acting Manager, Transport Airplane

Directorate, Aircraft Certification Service.

[FR Doc. 97–25417 Filed 9–24–97; 8:45 am]

BILLING CODE 4910–13–U

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

RIN 0960–AE53

Administrative Review Process;

Identification and Referral of Cases for

Quality Review Under the Appeals

Council’s Authority To Review Cases

on Its Own Motion

AGENCY: Social Security Administration.

ACTION: Proposed rules.

SUMMARY: We propose to amend our

regulations to include the rules under

which a decision or order of dismissal

that is issued after the filing of a request

for a hearing by an administrative law

judge (ALJ) will be referred to the

Appeals Council for possible review

under the Appeals Council’s existing

authority to review cases on its own

motion. The proposed rules concern

identification and referral procedures

that we currently follow to ensure the

accuracy of decisions at the ALJ-hearing

step (hearing level) of the administrative

review process, and new quality

assurance procedures that we are

proposing under the Plan for a New

Disability Claim Process approved by

the Commissioner of Social Security in

September 1994 (59 FR 47887). The

procedures set forth in the proposed

rules apply to dispositions at the

hearing level of the administrative

review process that are made by ALJs,

and also to dispositions at the hearing

level that are not made by ALJs but are

subject to review under the Appeals

Council’s own-motion authority. The

latter type of dispositions currently

consist of wholly favorable decisions

issued by attorney advisors and

adjudication officers.

DATES: To be sure that your comments

are considered, we must receive them

no later than November 24, 1997.

ADDRESSES: Comments should be

submitted in writing to the

Commissioner of Social Security, P.O.

Box 1585, Baltimore, MD 21235; sent by

telefax to (410) 966–2830; sent by E-mail

to ‘‘regulations@ssa.gov’’; or, delivered

to the Division of Regulations and

Rulings, Social Security Administration,

3–B–1 Operations Building, 6401

Security Boulevard, Baltimore, MD

21235, between 8:00 A.M. and 4:30 P.M.

on regular business days. Comments

may be inspected during these same

hours by making arrangements with the

contact person shown below.

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 about these

rules. For information on eligibility or

claiming benefits, call our national tollfree number, 1–800–772–1213.

SUPPLEMENTARY INFORMATION:

Background

Under procedures set forth in

§§ 404.967 ff. and 416.1467 ff., and

pursuant to a direct delegation of

authority from the Commissioner of

Social Security (see 61 FR 35844, 35852,

July 8, 1996), the Appeals Council, a

component in our Office of Hearings

and Appeals (OHA), reviews hearing

decisions and orders of dismissal issued

by ALJs of the Social Security

Administration (SSA). The Appeals

Council may review a decision or

dismissal action of an ALJ at the request

of a party to the action or, under

authority provided in §§ 404.969 and

416.1469, on its own motion. Through

the exercise of its authority to review

cases, the Appeals Council is

responsible for ensuring that the final

decisions of the Commissioner of Social

Security under titles II and XVI of the

Social Security Act (the Act), as

amended, are proper and in accordance

with the law, regulations, and binding

agency policy.

The Appeals Council’s authority to

review cases on its own motion also

applies, at present, to two types of

hearing-level cases that do not result in

decisions by ALJs. Under §§ 404.942

and 416.1442, attorney advisors of OHA

are temporarily authorized to conduct

certain prehearing proceedings and to

issue, where warranted by the

documentary evidence, wholly

favorable decisions. Under the

provisions of §§ 404.942 (e)(2) and (f)(3)

and 416.1442 (e)(2) and (f)(3), such

decisions are subject to review under

the own-motion authority of the

Appeals Council established in

§§ 404.969 and 416.1469. In addition,

under §§ 404.943 and 416.1443,

adjudication officers are authorized, for

test purposes, to conduct certain

prehearing proceedings and to issue,

where warranted by the documentary

evidence, wholly favorable decisions.

Under the provisions of

§§ 404.943(c)(2)(ii) and

416.1443(c)(2)(ii), such decisions are

also subject to review on the Appeals

Council’s own motion.

Under our regulations on the Appeals

Council’s procedures, if the Appeals

Council decides to review a case in

response to a request for review or on

its own motion, it may issue a decision

or remand the case to an ALJ. The

Appeals Council may also dismiss a

request for hearing for any reason that

the ALJ could have dismissed the

request.

A decision by the Appeals Council

‘‘to review’’ a hearing-level decision

means that the Appeals Council

assumes jurisdiction to cause that

decision not to be the final decision of

the Commissioner of Social Security. A

decision that the Appeals Council

‘‘reviews’’ will be replaced by a new

final action in the case, either by a

decision or dismissal order of the
Federal Register / Vol. 62, No. 186 / Thursday, September 25, 1997 / Proposed Rules 50267

Appeals Council or, if a hearing or other

hearing-level proceedings are required,

by a decision or dismissal order issued

following remand of the case from the

Council to an ALJ.

A decision by the Appeals Council to

review a case is made when, following

a preliminary consideration of all

aspects of the case to determine if

review is appropriate, the Council

issues a notice announcing a decision to

review. The Council’s standard notice of

review advises the parties of the reasons

for the review and (unless the Council

issues a wholly favorable decision upon

taking review) the issues to be

considered in proceedings before the

Council or before an ALJ on remand. In

instances in which the Council reviews

a hearing level decision that has been

issued based on the documentary

evidence without the holding of an oral

hearing by an ALJ, the parties have the

right to such a hearing, except where the

parties waive that right in writing.

The existing provisions in §§ 404.969

and 416.1469 on the Appeals Council’s

authority to review cases on its own

motion provide that the Appeals

Council itself may decide to review a

case within 60 days after the date of the

hearing decision or dismissal and that,

if the Council does review a case under

this authority, it will provide notice to

the parties to the hearing decision or

dismissal action. Sections 404.969 and

416.1469 do not currently address the

procedures we use in identifying and

referring cases to the Appeals Council

for it to consider for possible review on

its own motion.

The Appeals Council has broad

authority to review any case on its own

motion pursuant to §§ 404.969 and

416.1469. The conditions under which

the Appeals Council will review a case,

on request for review or on its own

motion, are set forth in §§ 404.970 and

416.1470. Those sections provide that

the Council will review a case if: (1)

There appears to be an abuse of

discretion by the ALJ; (2) there is an

error of law; (3) the action, findings or

conclusions of the ALJ are not

supported by substantial evidence; or

(4) there is a broad policy or procedural

issue that may affect the general public

interest. Sections 404.970 and 416.1470

further provide that the Council will

also review a case if new and material

evidence is submitted that relates to the

period on or before the date of the ALJ’s

decision and the Council finds, upon

evaluating the evidence of record and

the additional evidence, that an action,

a finding or a conclusion of the ALJ is

contrary to the weight of the evidence

currently of record as a whole.

In fiscal year 1996 (FY ’96), the

Appeals Council received 99,735

requests for review filed by parties to

the actions of ALJs. Most of the requests

were for review of unfavorable decisions

and dismissal actions; some concerned

partially favorable decisions. In FY ’96,

the Council also considered 8,602 cases

for possible review on its own motion.

Almost all of these cases involved

favorable hearing-level decisions that

were referred to the Appeals Council

under one of two types of identification

and referral procedures we currently

use—random sample procedures, which

generated the majority of this workload

in FY ’96, and ‘‘protest’’ procedures.

Existing Identification and Referral

Procedures

Section 304(g) of Public Law 96–265

(1980) required SSA to implement a

program for initiating review of ALJ

decisions in disability claims. Under

section 304(g), the Appeals Council

considers, for possible review on its

own motion, a national random sample

of favorable ALJ decisions that have not

been implemented, and, as resources

permit, a random sample of unappealed

denial decisions and dismissals. (See

Social Security Ruling 82–13.)

The Appeals Council also considers,

for possible review on its own motion,

a random sample of wholly favorable

decisions issued by attorney advisors

under the time-limited provisions of

§§ 404.942 and 416.1442. Wholly

favorable decisions issued by

adjudication officers under the testing

provisions of §§ 404.943 and 416.1443

are also identified by random sampling

for referral to the Appeals Council for

possible own-motion review. These

procedures have been established in

accordance with commitments we

made, in publishing the final rules for

the attorney advisor and adjudication

officer provisions, to assess carefully the

quality of the decisions issued by the

attorney advisors and the adjudication

officers (see 60 FR 34127 and 60 FR

47471, respectively).

Our existing identification and

referral procedures also include those

under which the SSA components

responsible for implementing hearinglevel decisions—SSA Processing

Centers (PCs) and Field Offices (FOs)—

refer (‘‘protest’’) certain cases to the

Appeals Council for possible review

under its own motion authority. The

PCs, which include our Program Service

Centers and the Office of Disability and

International Operations, refer cases

directly to the Appeals Council; FOs

forward cases to a PC or an SSA

Regional Office, which decides if the PC

or the Regional Commissioner should

make a referral to the Council.

The decisions of ALJs and the

decisions currently issued by attorney

advisors and adjudication officers are

subject to referral to the Appeals

Council under our protest procedures.

Almost all protested decisions are

favorable decisions because almost all of

the ALJ decisions that require

implementation are wholly or partially

favorable decisions under which benefit

payments are to be effectuated (initiated

or continued), and because all decisions

issued by attorney advisors and

adjudication officers are favorable. In

protesting a decision, an effectuating

component may recommend that the

decision be made more or less favorable

or unfavorable.

Effectuating components refer a case

if the need for referral is believed to be

clear (not dependent on a judgment

factor) because of one of the following

circumstances: (1) The decision

contains a clerical error which affects

the outcome of the claim; (2) the

decision is clearly contrary to the Act,

regulations or rulings; or (3) the

decision cannot be effectuated because

its intent is unclear as to an issue

affecting the claim’s outcome.

Effectuating components refer cases to

the Appeals Council by written

memoranda. If the Council decides to

review a referred case, it provides the

parties a copy of the effectuating

component’s referral memorandum with

the notice by which it advises the

parties that it will review the case.

We are proposing to amend our

regulations to include rules on the

existing random sample and protest

procedures discussed above. We have

decided to propose rules setting forth

these procedures in connection with our

decision to propose, in furtherance of

the Plan for a New Disability Claim

Process, that the Appeals Council’s

own-motion functions be strengthened

by establishment of a new process for

identifying and referring cases for

possible review under the Council’s

existing own-motion authority.

New Identification and Referral

Procedures

The Appeals Council currently

considers only a small percentage of all

favorable decisions issued at the hearing

level for possible review under its ownmotion authority. (In FY ’96, the

Council’s workload in this area

represented fewer than 3 percent of

such decisions in that year.) In addition,

the processes we currently use to select

decisions for possible review on the

Appeals Council’s own motion are

generally not designed to identify, in
50268 Federal Register / Vol. 62, No. 186 / Thursday, September 25, 1997 / Proposed Rules

any systematic way, hearing-level

decisions that are likely to be incorrect.

The random sample processes bringing

cases before the Appeals Council do not

identify cases other than by techniques

designed to assure randomness of

selection within broadly identified

categories (i.e., allowances, unappealed

denials, and dismissals). The

identification of ‘‘protest’’ cases that

occurs in the effectuation process is a

secondary function of a process that is

principally focused on the prompt

payment of benefits.

Based on the above considerations,

we are proposing to establish

procedures under which our Office of

Program and Integrity Reviews (OPIR),

the SSA component that oversees the

review of State agency determinations

made under section 221(c) of the Act,

will examine certain allowance

decisions at the hearing level and refer

to the Appeals Council the decisions

that may not be supported by the record.

Decisions that have been issued at the

hearing level will be included in the

OPIR-conducted examination process by

random sampling and, as we develop

the computer systems and other

technical capacities needed to support

this function, selective sampling that

will rely on case profiling and other

sampling techniques to identify cases

that involve problematic issues or fact

patterns that increase the likelihood of

error.

Under the proposed process, upon

referral of a case by OPIR, the Appeals

Council would consider the case and

OPIR’s reasons for believing the

decision is not supported by the record

and decide whether to review the case

in accordance with §§ 404.969–404.970

and/or 416.1469–416.1470. If the

Appeals Council decides to review an

OPIR-referred case, it would provide the

parties a copy of OPIR’s referral with its

notice of review. The 60-day time limit

for the Appeals Council to initiate

review of a case under the authority and

standards provided in §§ 404.969–

404.970 and 416.1469–416.1470 would

apply to cases the Council considers for

review in response to referrals from

OPIR.

Section 304(g) of Public Law 96–265

(see above) does not specify the kind of

identification and referral procedures

that SSA should use in implementing a

program for initiating review of ALJ

decisions in disability cases. We believe

that use of the new procedures we are

proposing, in combination with the

existing identification and referral

procedures that we are proposing to

regulate, would be consistent with the

kind of review contemplated by section

304.

An important purpose of the new

procedures we are proposing is to

increase our ability to identify policy

issues that should be clarified through

publication of regulations or rulings. We

plan to monitor how our policies are

understood and implemented by postadjudicative evaluation of cases that are

shown, as a result of their referral to the

Appeals Council, to pose significant

policy or program issues.

Proposed Regulations

We propose to revise §§ 404.969 and

416.1469, the regulations that set forth

the Appeals Council’s authority to

review cases on its own motion, to state

that we refer cases to the Appeals

Council for it to consider reviewing on

its own motion. As proposed for

revision, §§ 404.969 and 416.1469

describe the identification and referral

procedures we will follow and the

action of the Appeals Council in cases

it considers for possible review on its

own motion.

Sections 404.969 and 416.1469 as

proposed will apply to all cases that our

regulations make subject to review on

the Appeals Council’s own motion.

These currently include, in addition to

cases involving ALJ decisions and

dismissals, cases involving wholly

favorable decisions issued by attorney

advisors under the time-limited

provisions of §§ 404.942 and 416.1442,

and cases involving wholly favorable

decisions issued by adjudication officers

under the test procedures set out in

§§ 404.943 and 416.1443.

Proposed §§ 404.969(b) and

416.1469(b) specify that we will identify

a case for referral to the Appeals

Council for possible review under its

own-motion authority before we

effectuate a decision in the case. These

sections also provide that we will

identify cases for referral through

random and selective sampling

techniques, that we may use these

techniques in association with

examination of the cases identified by

sampling, and that we will also identify

cases for referral through the evaluation

of cases we conduct in order to

effectuate decisions.

Under §§ 404.969(b)(1) and

416.1469(b)(1) as proposed, we may

conduct random and selective sampling

of cases involving all types of actions

that occur at the hearing level of the

administrative review process (i.e.,

wholly or partially favorable decisions,

unfavorable decisions, or dismissals)

and any type of title II or title XVI

benefits (i.e., different types of benefits

based on disability and benefits not

based on disability). Our decision to

propose these rules rests on our

conclusion that we should increase the

number of favorable disability decisions

the Appeals Council considers for

possible review on its own motion to

better balance review of favorable and

unfavorable decisions. However, the

Council’s existing authority to review

cases on its own motion covers all types

of title II and title XVI cases adjudicated

at the hearing level, and these proposed

rules will allow use of the identification

and referral procedures being set forth

with respect to all such cases.

Sections 404.969(b)(1) and

416.1469(b)(1) as proposed specify that

we will use selective sampling to

identify cases that exhibit problematic

issues or fact patterns that increase the

likelihood of error. Under the provisions

as proposed, the factors considered in

selective sampling will not include the

identity of the decisionmaker or the

identity of the office issuing the

decision.

Proposed §§ 404.969(b)(1) and

416.1469(b)(1) also authorize but do not

require that we examine cases that have

been identified through random or

selective sampling. Cases may be

identified for referral by random or

selective sampling. The purpose of the

examination of cases that we may

conduct is to refine the identification of

cases in which the action that has been

taken is not supported.

Proposed §§ 404.969(b)(2) and

416.1469(b)(2) provide that effectuating

components will identify cases for

referral under criteria presently used to

identify clear error and circumstances

preventing effectuation of a decision.

Any type of decision requiring

effectuation may be identified for

referral under these provisions.

Under §§ 404.969(c) and 416.1469(c),

as proposed, we will make referrals that

occur as the result of a case examination

or the effectuation process in writing.

The written referral will state the

referring component’s reasons for

believing that the Appeals Council

should review the case on its own

motion. Sections 404.969(c) and

416.1469(c) as proposed also provide

that referrals resulting from selective

sampling without a case examination

may be accompanied by a written

statement identifying the issue(s) or fact

pattern that caused the referral, and that

referrals resulting from random

sampling without a case examination

will only identify the case as a random

sample case. A statement of the issue(s)

or fact pattern identified in selective

sampling may be computer generated.

Proposed §§ 404.969(d) and

416.1469(d) specify that the Appeals

Council’s notice of review will include

a copy of any written referral provided
Federal Register / Vol. 62, No. 186 / Thursday, September 25, 1997 / Proposed Rules 50269

to the Appeals Council. These

provisions also include language to state

clearly our long-standing policy that

issuance of the notice of review

establishes when a decision to conduct

a review occurs.

We are also proposing to include in

§§ 404.969(d) and 416.1469(d) a

statement specifying our policy that,

when the Appeals Council is unable to

decide whether to review a case on its

own motion within the 60-day period in

which it may do so, it may consider

whether the decision should be

reopened under the provisions of

§§ 404.987 and/or 416.1487, which

authorize the Council to reopen a final

decision on its own initiative or at the

request of a party to the decision, if a

condition for reopening stated in

§§ 404.988 and/or 416.1488 is present.

We are including this statement in the

regulations to clarify our long-standing

policy that the Appeals Council may

also reopen final decisions in

accordance with §§ 404.987 and

416.1487 after the 60 days for initiating

review under §§ 404.969 and 416.1469

have expired.

Electronic Version

The electronic file of this document is

available on the Federal Bulletin Board

(FBB) at 9:00 a.m. on the date of

publication in the Federal Register. To

download the file, modem dial (202)

512–1387. The FBB instructions will

explain how to download the file and

the fee. This file is in WordPerfect and

will remain on the FBB during the

comment period.

Regulatory Procedures

Executive Order 12866

We have consulted with the Office of

Management and Budget (OMB) and

determined that these rules do meet the

criteria for a significant regulatory

action under Executive Order 12866.

They were therefore submitted to OMB

for review.

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 SecurityDisability Insurance; 96.002, Social SecurityRetirement Insurance; 96.003, Social

Security-Special Benefits for Persons Aged 72

and Over; 96.004, Social Security-Survivors

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 recordkeeping

requirements.

Dated: September 12, 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 proposed to be 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 is revised 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. 304(g), Pub. L. 96–265, 94

Stat. 456 (42 U.S.C. 421 note); 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. Section 404.969 is revised to read

as follows:

§ 404.969 Appeals Council initiates review.

(a) General. Anytime within 60 days

after the date of a decision or dismissal

that is subject to review under this

section, the Appeals Council may

decide on its own motion to review the

action that was taken in your case. We

may refer your case to the Appeals

Council for it to consider reviewing

under this authority.

(b) Identification of cases. We will

identify a case for referral to the

Appeals Council for possible review

under its own-motion authority before

we effectuate a decision in the case. We

will identify cases for referral to the

Appeals Council through random and

selective sampling techniques, which

we may use in association with

examination of the cases identified by

sampling. We will also identify cases for

referral to the Appeals Council through

the evaluation of cases we conduct in

order to effectuate decisions.

(1) Random and selective sampling

and case examinations. We may use

random and selective sampling to

identify cases involving any type of

action (i.e., wholly or partially favorable

decisions, unfavorable decisions, or

dismissals) and any type of benefits (i.e.,

benefits based on disability and benefits

not based on disability). We will use

selective sampling to identify cases that

exhibit problematic issues or fact

patterns that increase the likelihood of

error. Our selective sampling

procedures will not identify cases based

on the identity of the decisionmaker or

the identity of the office issuing the

decision. We may examine cases that

have been identified through random or

selective sampling to refine the

identification of cases in which the

action taken may not be supported by

the record.

(2) Identification as a result of the

effectuation process. We may refer a

case requiring effectuation to the

Appeals Council if the decision cannot

be effectuated because it contains a

clerical error affecting the outcome of

the claim; the decision is clearly

inconsistent with the Social Security

Act, the regulations, or a published

ruling; or the decision is unclear

regarding a matter that affects the

claim’s outcome.

(c) Referral of cases. We will make

referrals that occur as the result of a case

examination or the effectuation process

in writing. The written referral based on

the results of such a case examination

or the effectuation process will state the

referring component’s reasons for

believing that the Appeals Council

should review the case on its own

motion. Referrals that result from

selective sampling without a case

examination may be accompanied by a

written statement identifying the

issue(s) or fact pattern that caused the

referral. Referrals that result from

random sampling without a case

examination will only identify the case

as a random sample case.

(d) Appeals Council’s action. If the

Appeals Council decides to review a

decision or dismissal on its own motion,

it will mail a notice of review to all the

parties as provided in § 404.973. The

Appeals Council will include with that

notice a copy of any written referral it

has received under paragraph (c) of this

section. The Appeals Council’s decision
50270 Federal Register / Vol. 62, No. 186 / Thursday, September 25, 1997 / Proposed Rules

to review a case is established by its

issuance of the notice of review. If it is

unable to decide within the applicable

60-day period whether to review a

decision or a dismissal, the Appeals

Council may consider the case to

determine if the decision or dismissal

should be reopened pursuant to

§ 404.987.

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

is revised to read as follows:

Authority: Sec. 702(a)(5), 1631, and 1633

of the Social Security Act (42 U.S.C.

902(a)(5), 1383, and 1383b); sec. 304(g), Pub.

L. 96–265, 94 Stat. 456 (42 U.S.C. 421 note).

2. Section 416.1469 is revised to read

as follows:

§ 416.1469 Appeals Council initiates

review.

(a) General. Anytime within 60 days

after the date of a decision or dismissal

that is subject to review under this

section, the Appeals Council may

decide on its own motion to review the

action that was taken in your case. We

may refer your case to the Appeals

Council for it to consider reviewing

under this authority.

(b) Identification of cases. We will

identify a case for referral to the

Appeals Council for possible review

under its own-motion authority before

we effectuate a decision in the case. We

will identify cases for referral to the

Appeals Council through random and

selective sampling techniques, which

we may use in association with

examination of the cases identified by

sampling. We will also identify cases for

referral to the Appeals Council through

the evaluation of cases we conduct in

order to effectuate decisions.

(1) Random and selective sampling

and case examinations. We may use

random and selective sampling to

identify cases involving any type of

action (i.e., wholly or partially favorable

decisions, unfavorable decisions, or

dismissals) and any type of benefits (i.e.,

benefits based on disability and benefits

not based on disability). We will use

selective sampling to identify cases that

exhibit problematic issues or fact

patterns that increase the likelihood of

error. Our selective sampling

procedures will not identify cases based

on the identity of the decisionmaker or

the identity of the office issuing the

decision. We may examine cases that

have been identified through random or

selective sampling to refine the

identification of cases in which the

action taken may not be supported by

the record.

(2) Identification as a result of the

effectuation process. We may refer a

case requiring effectuation to the

Appeals Council if the decision cannot

be effectuated because it contains a

clerical error affecting the outcome of

the claim; the decision is clearly

inconsistent with the Social Security

Act, the regulations, or a published

ruling; or the decision is unclear

regarding a matter that affects the

claim’s outcome.

(c) Referral of cases. We will make

referrals that occur as the result of a case

examination or the effectuation process

in writing. The written referral based on

the results of such a case examination

or the effectuation process will state the

referring component’s reasons for

believing that the Appeals Council

should review the case on its own

motion. Referrals that result from

selective sampling without a case

examination may be accompanied by a

written statement identifying the

issue(s) or fact pattern that caused the

referral. Referrals that result from

random sampling without a case

examination will only identify the case

as a random sample case.

(d) Appeals Council’s action. If the

Appeals Council decides to review a

decision or dismissal on its own motion,

it will mail a notice of review to all the

parties as provided in § 416.1473. The

Appeals Council will include with that

notice a copy of any written referral it

has received under paragraph (c) of this

section. The Appeals Council’s decision

to review a case is established by its

issuance of the notice of review. If it is

unable to decide within the applicable

60-day period whether to review a

decision or dismissal, the Appeals

Council may consider the case to

determine if the decision or dismissal

should be reopened pursuant to

§ 416.1487.

[FR Doc. 97–25365 Filed 9–24–97; 8:45 am]

BILLING CODE 4190–29–U

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]

RIN 0960–AE56

Federal Old-Age, Survivors, and

Disability Insurance and Supplemental

Security Income for the Aged, Blind,

and Disabled; Evaluating Opinion

Evidence

AGENCY: Social Security Administration.

ACTION: Proposed rules.

SUMMARY: We propose to revise the

Social Security and supplemental

security income (SSI) regulations about

the evaluation of medical opinions to

clarify how administrative law judges

and the Appeals Council are to consider

opinion evidence from State agency

medical and psychological consultants,

other program physicians and

psychologists, and medical experts we

consult in claims for disability benefits

under titles II and XVI of the Social

Security Act (the Act). We also propose

to define or clarify several terms used in

our regulations and to delete other

terms.

DATES: To be sure that your comments

are considered, we must receive them

no later than November 24, 1997.

ADDRESSES: Comments should be

submitted in writing to the

Commissioner of Social Security, P.O.

Box 1585, Baltimore, MD 21235, sent by

telefax to (410) 966–2830, sent by E-mail

to ‘‘regulations@ssa.gov,’’ or delivered

to the Division of Regulations and

Rulings, Social Security Administration,

3–B–1 Operations Building, 6401

Security Boulevard, Baltimore, MD

21235, between 8:00 a.m. and 4:30 p.m.

on regular business days. Comments

may be inspected during these same

hours by making arrangements with the

contact person shown below.

FOR FURTHER INFORMATION CONTACT:

Richard M. Bresnick, Legal Assistant,

Division of Regulations and Rulings,

Social Security Administration, 6401

Security Boulevard, Baltimore, MD

21235, (410) 965–1758 for information

about these rules. For information on

eligibility or filing for benefits, call our

national toll-free number, 1–800–772–

1213.

SUPPLEMENTARY INFORMATION: The Act

provides, in title II, for the payment of

disability benefits to persons insured

under the Act. Title II also provides,

under certain circumstances, for the

payment of child’s insurance benefits

based on disability and widow’s and

widower’s insurance benefits for

disabled widows, widowers, and

surviving divorced spouses of insured

persons. In addition, the Act provides,

in title XVI, for SSI payments to persons

who are aged, blind, or disabled and

who have limited income and resources.

For adults under both the title II and

title XVI programs (including persons

claiming child’s insurance benefits

based on disability under title II),

‘‘disability’’ means the inability to

engage in any substantial gainful

activity. For an individual under age 18

claiming SSI benefits based on