Federal Register / Vol. 60, No. 78 / Monday, April 24, 1995 / Rules and Regulations 20023

enters into a binding contract with a holder

of the issuer’s debt obligation to exchange

that security at a future date for specified

amount may be subject to conflicting

literature. The staff intends to request that

the Emerging Issues Task Force address that

issue.

[FR Doc. 95–9981 Filed 4–21–95; 8:45 am]

BILLING CODE 8010–01–M

SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]

RIN 0960–AD63

Testing Modifications to the Disability

Determination Procedures

AGENCY: Social Security Administration

(SSA).

ACTION: Final rules.

SUMMARY: We are adding new rules

which provide authority to test

procedures that modify the disability

determination process we currently

follow under titles II and XVI of the

Social Security Act (the Act). We intend

to test up to four model procedures

either singly or in combination. These

tests will provide us with information

so we can determine the effectiveness of

the models in improving the disability

process. The intended result is to enable

us to make recommendations for

national implementation of

improvements identified by the tests.

These final rules only refer to the

changes to the disability procedures we

may test. Unless specified, all other

regulations related to the disability

determination process remain

unchanged. Videoconferencing may be

used with any of the models.

EFFECTIVE DATE: These rules are effective

April 24, 1995.

FOR FURTHER INFORMATION CONTACT:

Henry D. Lerner, Legal Assistant, Office

of Regulations, Social Security

Administration, 6401 Security Blvd.,

Baltimore, MD 21235, (410) 965–1762.

SUPPLEMENTARY INFORMATION:

Background

We published a notice of proposed

rulemaking (NPRM) in the Federal

Register on October 22, 1993, (58 FR

54532) proposing to establish the

authority to test model projects

designed to improve the disability

determination process. The initial

public comment period was 30 days. A

30-day extension of the public comment

period was published in the Federal

Register on December 6, 1993, (58 FR

64207) and the comment period ended

on January 5, 1994. The comments we

received on the NPRM and the changes

we have made in the final rules are

discussed below.

On April 15, 1994, the Social Security

Administration (SSA) published a

notice in the Federal Register (59 FR

18188) setting out a proposal to redesign

the initial and administrative appeals

system for determining an individual’s

entitlement to Social Security and

Supplementary Security Income (SSI)

disability payments. Comments on this

comprehensive and far reaching

proposal developed by SSA’s Disability

Process Reengineering Team (the Team)

were requested, and during the

comment period that began on April 1,

1994, and ended on June 14, 1994, SSA

received over 6,000 written responses.

They came from a broad spectrum of

respondents including: Professional

associations, claimant representatives,

claimant advocacy groups, Federal and

State agencies, State governments,

employee unions, Federal and State

employees, and other members of the

public. Comments also were received by

members of the Team who conducted

briefings and spoke with more than

3,000 individuals about their reaction to

the proposal. The commenters

expressed their belief that

improvements were needed to provide

better service and to manage the claims

process more effectively. While some

concerns were expressed, the

commenters praised SSA and the Team

for taking on the task of redesigning the

disability claim process.

The Team made revisions to the

redesign proposal and submitted them

to the Commissioner of Social Security

on June 30, 1994. The Commissioner

accepted the recommendations of the

Team on September 7, 1994, with the

full understanding that certain aspects

of the redesign proposal recommended

by the Team would require extensive

research and testing to determine

whether they can be implemented. The

plan approved by the Commissioner

was published in the Federal Register

on September 19, 1994 (59 FR 47887).

The proposed changes to the disability

determination process contained in the

plan approved by the Commissioner

that are the same as or similar to

changes we proposed to test in the

NPRM include:

• Making the process more

personalized by assigning a disability

claim manager who is knowledgeable

about the case to be the claimant’s

principal contact with SSA;

• Providing the claimant with an

opportunity for a predecision interview

with the decisionmaker(s) when the

decisionmaker finds that the evidence

in the claim file is insufficient to make

a fully favorable determination or

requires an initial determination

denying the claim;

• Eliminating the reconsideration

step of the administrative review

process and providing a claimant who is

dissatisfied with his or her initial

determination with the opportunity to

request a hearing before an

administrative law judge (ALJ).

These final rules were developed

based on the NPRM, the comments we

received on it which are discussed

below, and the Commissioner’s

acceptance on September 7, 1994, of the

Team’s recommendations to redesign

the disability process. Under the final

rules we plan to test one or more

modifications to the current disability

determination process to determine

whether the modifications should

become permanent. The modifications

we plan to test pursuant to these final

rules that were not contained in the

NPRM, are based on, and are an

outgrowth of, the NPRM.

Some modifications of procedures

that were in the NPRM, such as having

a single decisionmaker in the proposed

claims intake and determination model,

the face-to-face predenial interview

model and the face-to-face Federal

reconsideration models, are now found

in these final rules in the single

decisionmaker model. Also, a

modification similar to, though less

formal than, the predenial interview

concept that was part of the face-to-face

predenial interview model is now found

in the predecision interview model.

Other modifications contained within

the models described in the NPRM and

the redesign proposal are now combined

in models in these final rules. For

example, the NPRM described a

disability specialist as a claims

representative who would be given

special disability program training

similar to the training that State agency

disability examiners receive. The

disability specialist would be able to

review the claim before forwarding it to

the State agency, request and evaluate

existing medical evidence and, if

appropriate, arrange for a consultative

examination. With respect to

applications for SSI payments based on

disability, the disability specialist

would, where appropriate, make

presumptive disability findings. The

second model in the NPRM, the claims

intake and determination model,

described a process whereby the

applicant would be interviewed by a

decisionmaker when a claim for

disability benefits or SSI payments

based on disability was filed.
20024 Federal Register / Vol. 60, No. 78 / Monday, April 24, 1995 / Rules and Regulations

Whereas the NPRM described a

disability specialist and a

decisionmaker at claims intake who

could perform these functions, the final

rules now have a disability claim

manager model and a single

decisionmaker model. The disability

claim manager will assume primary

responsibility for the processing of any

initial disability claim, and he or she

will act as the focal point for the

claimant’s contacts with us throughout

the claims intake process and until an

initial determination is issued. The

disability claim manager will perform

many of the functions associated with a

disability specialist, but will also

perform other functions. A disability

claim manager will provide the claimant

with an explanation of the disability

programs, including the definition of

disability and how we determine

whether or not the claimant meets the

other requirements for entitlement to

disability benefits. The disability claim

manager will also explain what the

claimant will be asked to do throughout

the initial claims process and provide

information that will assist the claimant

in pursuing his or her claim. When

tested in combination with the single

decisionmaker model, the disability

claim manager will also be the

decisionmaker, similar to the

decisionmaker in the claims intake and

determination model described in the

NPRM.

The disability claim manager may

work in a team environment with

medical consultants who provide

assistance for case adjudication, as well

as with technical and other clerical

personnel who may handle other

aspects of case development and

payment effectuation. Each team

member will have a familiarity with all

the steps in the process and an

understanding of how he or she assists

another’s efforts. Team members will be

able to draw upon each other’s expertise

on complex issues. We expect that this

team environment, combined with the

proper training, program tools and

technological support, will eventually

enable one individual to handle the

responsibilities of the disability claim

manager. This individual may be either

a Federal employee or a State agency

employee. An individual employee

serving as the disability claim manager

is basic to our objective of providing a

single point of contact for the claimant

during the initial disability process.

In the near term, it may be necessary

to have the duties of a disability claim

manager carried out by more than one

individual and, therefore, to expand the

‘‘disability team’’ described above to

include additional employees. The final

rules will allow us to test the disability

claim manager function performed by

one individual or a team of individuals.

If the disability claim manager model is

being tested in combination with the

single decisionmaker model (i.e., the

disability claim manager would be the

single decisionmaker for both the

medical and nonmedical aspects of the

claim), and a State agency employee is

performing the duties of the disability

claim manager, the ultimate

determination of whether or not the

claimant is entitled to benefits will be

made by a team that includes a Federal

employee. This procedure is in

accordance with current provisions of

the Act which authorize State agency

employees only to make determinations

of disability and not determinations of

entitlement to benefits based on

disability.

The disability models proposed in the

NPRM were designed only to modify

those aspects of the disability

determination process based upon the

medical factors of entitlement. That is

why, for example, the face-to-face

predenial interview model proposed in

the NPRM only provided for direct

appeal of disability issues to the ALJ.

Since then, we have decided to test

ways to improve both the disability and

nondisability aspects of the disability

determination process. The face-to-face

predenial interview model with limited

direct appeal rights to the ALJ has been

changed in the final rules to a less

formal predecision interview model. As

some commenters suggested, the

predecision interview model does not

place conditions on a claimant’s appeal

rights. It still provides, however, the

claimant with the opportunity for an

interview with the decisionmaker(s)

before an initial determination denying

the claim is made or when the evidence

is insufficient to make a fully favorable

determination. The decisionmaker(s)

who will conduct the interview has the

discretion to determine which method

of interview (face-to-face,

videoconferencing, or telephone) is

most appropriate for each claimant’s

special needs. The reconsideration

elimination model has also been

modified to allow appeal to an

administrative law judge if the claimant

is dissatisfied with the initial

determination made in his or her claim,

based upon either disability or

nondisability factors.

Finally, we decided not to test the

face-to-face Federal reconsideration

model described in the NPRM because

its primary benefit, namely, an earlier

opportunity to appear before a Federal

decisionmaker is now contained within

the single decisionmaker model.

These regulations provide the

authority to test major elements of our

Disability Redesign Plan. However,

there are elements of the Redesign not

referenced in these final regulations.

There are two principal reasons why

elements are omitted. First, we do not

need regulatory authority to test or

implement many aspects of the

Redesign (e.g., improved public

information materials or more efficient

ways of working with applicants to

obtain medical evidence). Second, some

elements of the Redesign were not

referenced in the NPRM, since the

Redesign was developed subsequent to

issuance of the NPRM. Therefore,

separate regulations will be needed for

those elements which are beyond the

scope of the original rulemaking.

For example, separate regulations are

required to establish the position of an

adjudication officer who is authorized

to issue some disability decisions.

Current implementation planning for

the Disability Redesign includes the

development of regulations to test the

adjudication officer element in the

Redesign. We plan to test the

adjudication officer in combination with

one or more of the models included in

these regulations as well as other

aspects of the Redesign in some test

sites. This will provide us with a body

of information about each individual

part of the Redesign as well as the

combined effect on individuals and on

program expenditures of the overall

Redesign.

Public Comments

We received comments on the NPRM

from twenty-one commenters. The

commenters included attorneys,

medical professionals, advocates, State

agency employees and Federal

employees, and representatives of

numerous organizations that represent

the disabled. We received no comments

from persons receiving benefits based

on disability. Many commenters

supported and applauded us for

undertaking tests of models that modify

the disability determination process.

These commenters included the ARC

(formerly known as the Association for

Retarded Citizens of the United States);

the American Academy of Pediatrics;

the American Foundation for the Blind;

the United Cerebral Palsy Associations;

the Administrative Conference of the

United States; the Council for

Exceptional Children; and the National

Council on Disability. Some of the

comments we received were outside the

scope of the proposed rules, and

therefore, have not been addressed. The

substantive comments made by the
Federal Register / Vol. 60, No. 78 / Monday, April 24, 1995 / Rules and Regulations 20025

commenters and our responses are

summarized below.

Comment: Many commenters raised

concerns regarding the adequacy of the

training that would be provided to

interviewers and decisionmakers

(particularly single decisionmakers).

Response: We will ensure that the

interviewers and decisionmakers who

participate in our tests will be highly

trained individuals who are well versed

in both the disability and nondisability

aspects of the disability programs and

are individuals who have the necessary

knowledge, skills, and abilities to

conduct personal interviews, develop

evidentiary records, and fully adjudicate

disability claims, as appropriate. These

individuals will also be able to call on

other SSA resources, including medical

and technical support personnel, to

provide advice and assistance in the

claims process.

Comment: Several commenters raised

concerns regarding the apparent lack of

involvement of the medical consultant

in making disability determinations

because the medical consultant would

not be required to sign the disability

determination forms used to certify the

determination of disability to us.

Response: The fact that we intend to

test a model or combinations of models

where the determination of disability is

made by a single decisionmaker does

not mean that the medical consultant is

being removed from the decisionmaking

process. The decisionmaker will consult

with the medical consultant whenever

appropriate. This means that the

decisionmaker will make reasonable

efforts to ensure that a qualified

pediatrician or other appropriate

specialist evaluates the claim whenever

a determination of disability is required

in claims filed on behalf of children

under age 18 claiming SSI payments

based on disability. Similarly, before

making a determination that an

individual is not under a disability in

any case which indicates the existence

of a mental impairment, the

decisionmaker will make every

reasonable effort to ensure that a

qualified psychiatrist or psychologist

completes the medical portion of the

case review and any applicable residual

functional assessment. In addition, the

decisionmaker will consult with the

medical consultant in all other

situations where the decisionmaker

finds that a consultation is appropriate.

However, the single decisionmaker

concept is based on the premise that the

decisionmaker is fully competent to

make an initial determination when an

individual files an application for

benefits based on disability. It also gives

the decisionmaker flexibility to make

such determinations without having to

wait for the medical consultant to take

part formally in the determination.

Comment: Several commenters

wanted us to include quality

assessments of accuracy in our

evaluation of all possible approaches to

improved disability determinations. The

commenters’ concerns stem partially

from the use of a single decisionmaker

in some of the proposed models and

from the fact that medical consultants

will not be required to sign the

disability determination forms used to

certify the determination of disability to

us.

Response: Our evaluation of the

models we test will include quality

assurance procedures to ensure a

thorough assessment of the accuracy of

the disability determinations made

under the test procedures. As previously

noted, decisionmakers will comply with

the statutory requirements regarding the

use of medical consultants in SSI

childhood disability claims, and in all

denials of claims based upon mental

impairments. In addition, such

consultation will take place with respect

to any other claim in which the

decisionmaker finds it is appropriate to

consult with the medical consultant.

Comment: One commenter was

concerned with how we would evaluate

the success and impact of the model

procedures.

Response: We will have a study

design and evaluation plan in place to

assure a valid and accurate assessment

of the degree to which the modifications

to the disability determination process

we test attain the goals we wish to

achieve before any national

implementation of the modifications

begins.

Comment: Several commenters

expressed concerns that the proposed

models did not appear to make any

provisions for applicants requiring

special assistance—e.g., individuals

with mental impairments, older

persons, the homeless, etc.

Response: The modifications to the

disability determination process we test

will not compromise any provisions that

we currently have to provide

accommodations for those individuals

who require special assistance. As we

stated in the summary sections of the

NPRM and final rules, all other

regulations related to the disability

determination procedures remain

unchanged unless specified. This would

include provisions for claimants who

may require special assistance. In fact,

the disability claim manager model we

now intend to test provides even more

flexibility and opportunity to assist

claimants who may require special

assistance. The disability claim

manager, acting as the focal point for the

claimant’s contacts with us throughout

the initial disability process, will

explain the disability programs to the

claimant, including the definition of

disability and how SSA determines if a

claimant meets the disability

requirements of the Act. The disability

claim manager will also tell the

claimant what he or she will be asked

to do throughout the process, what the

claimant may expect from SSA during

the process, and how the claimant can

interact with the disability claim

manager to obtain more information or

assistance. The disability claim manager

will also advise the claimant regarding

the right to representation and provide

the appropriate referral sources for

representation.

Comment: Several commenters were

concerned regarding the use of

videoconferencing as a substitute for

personal face-to-face interviews,

because videoconferencing may not

carry the same weight as a face-to-face

interview and the lack of personal

contact could make the applicant feel

depersonalized. In addition, some

commenters expressed concerns that

videoconferencing may not be an option

for those claimants with special needs

such as those with visual or hearingrelated disabilities, or for those

individuals who could not provide their

own videoconferencing equipment.

Response: The testing of

videoconferencing as an alternative to a

personal face-to-face interview was

proposed and is included in these final

rules because it has the potential of

becoming a viable and more convenient

alternative for many claimants who

would find it a hardship or

impossibility to travel for an interview,

but who still wanted to take advantage

of the opportunity of an interview with

the decisionmaker prior to the

determination of disability. An

interview conducted via video or via the

telephone will carry the same weight as

an interview conducted face-to-face. In

these final rules the decisionmaker(s)

who will conduct the interview has the

discretion to determine which method

of interview (face-to-face,

videoconferencing, or telephone) is

most appropriate for each claimant’s

special needs. If we decide to conduct

a claimant’s interview via

videoconferencing, we will provide the

necessary videoconferencing services

for the claimant. We are exploring and

testing the option of videoconferencing

at all levels of the claims process, both

within and outside the projects to be

done under these regulations.
20026 Federal Register / Vol. 60, No. 78 / Monday, April 24, 1995 / Rules and Regulations

Regulatory authority to offer it as a

service option is not needed.

Comment: We received several

comments regarding claimant due

process rights and the possibility that

they could be compromised by some of

the models.

Response: None of the models we

intend to test will compromise or

diminish the claimant’s due process

rights. In fact, the disability claim

manager model we now intend to test

provides a process that is committed to

keeping the claimant more informed

regarding his or her rights and allows

the claimant to obtain information and

assistance more easily. Also, in the

context of ensuring a fair and correct

initial determination of disability, the

predecision interview model provides

the claimant an opportunity to have an

interview with the decisionmaker(s) and

to submit additional evidence before an

initial determination denying the claim

is made or when the evidence in file is

insufficient to make a fully favorable

determination.

Comment: Several commenters were

interested in having us test the models

that involved face-to-face contact with

the decisionmaker(s) prior to the initial

disability determination in combination

with the reconsideration elimination

model.

Response: These final rules provide

us with the flexibility to test models

individually or in combination with

other models. Therefore, we may test

model(s) involving the opportunity for

face-to-face contact between the

claimant and the decisionmaker(s) with

the reconsideration elimination model.

Comment: Several commenters were

concerned with the fact that the face-toface predenial interview model only

provided direct appeal of disability

issues involved in the initial

determination to the ALJ.

Response: These final rules have been

revised to allow appeal of both

disability and nondisability factors to

the ALJ whenever any of the first three

models are tested in combination with

the reconsideration elimination model.

As stated earlier, the face-to-face

predenial interview model with limited

direct appeal rights to the

administrative law judge has been

changed in the final rule to a less formal

predecision interview model. The

predecision interview model does not

place conditions on a claimant’s appeal

rights, but still provides the claimant

with the opportunity for a face-to-face

interview with the decisionmaker(s)

when the decisionmaker finds that the

evidence in the file is insufficient to

make a fully favorable determination or

requires an initial determination

denying the claim. The reconsideration

elimination model has also been

modified to allow appeal to the ALJ if

the claimant is dissatisfied with the

initial determination made on his or her

claim, based upon either medical or

nonmedical factors.

Comment: Several commenters were

concerned that there was no specific

indication as to whether children’s

claims would be included in the tests.

Response: As stated previously, the

summary section of the NPRM and these

final rules state that all other regulations

related to the disability determination

procedures remain unchanged unless

specified. That includes the rules for

determinations of disability in children.

We have no plans to exclude claims

filed by or behalf of children from the

tests. As stated previously, the

decisionmaker will make reasonable

efforts to ensure that a qualified

pediatrician or other appropriate

specialist evaluates the claim whenever

a determination of disability is required

in claims filed by or on behalf of

children under age 18 claiming SSI

benefits based on disability. We have no

intention of compromising any of the

safeguards currently in place to protect

the rights of children in the disability

determination process.

Comment: Several commenters were

concerned that the models would

generate increased workload demands

(particularly the elimination of the

reconsideration model and its predicted

effect of increasing ALJ workloads) and

some felt that some of the models would

be too costly.

Response: These types of concerns are

one of the reasons why we proposed

testing, rather than implementing

changes to our current rules. If the

model process or combination of

processes we test proves to be

prohibitively costly or to create

unmanageable workloads or both, we

will either drop the model from

consideration or revise the model

process to address the problem.

Regulatory Procedures

Executive Order 12866

The Office of Management and Budget

(OMB) has reviewed these final rules

and determined they do not meet the

criteria for a significant regulatory

action under E.O. 12866.

Paperwork Reduction Act

Data collection involved in the

evaluation of any of the models may

necessitate new reporting or

recordkeeping requirements which may

need clearance by OMB. These

requirements are still being developed.

When specifics have been determined,

any necessary request for clearance will

be forwarded to OMB as required by the

Paperwork Reduction Act.

Regulatory Flexibility Act

We certify that these regulations will

not have a significant economic impact

on a substantial number of small entities

because they affect individuals.

Therefore, a regulatory flexibility

analysis as provided in Pub. L. 96–354,

the Regulatory Flexibility Act, is not

required.

(Catalog of Federal Domestic Assistance

Program Nos. 93.802, Social SecurityDisability Insurance; 93.807, Supplemental

Security Income)

List of Subjects

20 CFR Part 404

Administrative practice and

procedure, Death benefits, Disability

benefits, Old-Age, Reporting and

recordkeeping requirements, Survivors

and Disability insurance.

20 CFR Part 416

Administrative practice and

procedure, Aged, Blind, Disability

benefits, Public assistance programs,

Reporting and recordkeeping

requirements, Supplemental Security

Income.

Dated: February 15, 1995.

Shirley Chater,

Commissioner of Social Security.

Approved: March 30, 1995.

Donna E. Shalala,

Secretary of Health and Human Services.

For the reasons set out in the

preamble, parts 404 and 416 of chapter

III of title 20 of the Code of Federal

Regulations are amended as set forth

below.

PART 404—FEDERAL OLD-AGE,

SURVIVORS AND DISABILITY

INSURANCE (1950– )

Subpart J is amended as follows:

1. The authority citation for subpart J

of part 404 continues to read as follows:

Authority: Secs. 201(j), 205 (a), (b), (d)–(h),

and (j), 221(d), and 1102 of the Social

Security Act; 31 U.S.C. 3720A; 42 U.S.C.

401(j), 405(a), (b), (d)–(h), and (j), 421(d), and

1302, sec. 5 of Pub. L. 97–455, 96 Stat. 2500;

sec. 6 of Pub. L. 98–460, 98 Stat. 1802.

2. Section 404.906 is revised to read

as follows:

§ 404.906 Testing modifications to the

disability determination procedures.

(a) Applicability and scope.

Notwithstanding any other provision in

this part or part 422 of this chapter, we

are establishing the procedures set out
Federal Register / Vol. 60, No. 78 / Monday, April 24, 1995 / Rules and Regulations 20027

in this section to test modifications to

our disability determination process.

These modifications will enable us to

test, either individually or in one or

more combinations, the effect of: having

disability claim managers assume

primary responsibility for processing an

application for disability benefits;

providing persons who have applied for

benefits based on disability with the

opportunity for an interview with a

decisionmaker when the decisionmaker

finds that the evidence in the file is

insufficient to make a fully favorable

determination or requires an initial

determination denying the claim;

having a single decisionmaker make the

initial determination with assistance

from medical consultants, where

appropriate; and eliminating the

reconsideration step in the

administrative review process and

having a claimant who is dissatisfied

with the initial determination request a

hearing before an administrative law

judge. The model procedures we test

will be designed to provide us with

information regarding the effect of these

procedural modifications and enable us

to decide whether and to what degree

the disability determination process

would be improved if they were

implemented on a national level.

(b) Procedures for cases included in

the tests. Prior to commencing each test

or group of tests in selected site(s), we

will publish a notice in the Federal

Register. The notice will describe which

model or combinations of models we

intend to test, where the specific test

site(s) will be, and the duration of the

test(s). The individuals who participate

in the test(s) will be randomly assigned

to a test group in each site where the

tests are conducted. Paragraphs (b) (1)

through (4) of this section lists

descriptions of each model.

(1) In the disability claim manager

model, when you file an application for

benefits based on disability, a disability

claim manager will assume primary

responsibility for the processing of your

claim. The disability claim manager will

be the focal point for your contacts with

us during the claims intake process and

until an initial determination on your

claim is made. The disability claim

manager will explain the disability

programs to you, including the

definition of disability and how we

determine whether you meet all the

requirements for benefits based on

disability. The disability claim manager

will explain what you will be asked to

do throughout the claims process and

how you can obtain information or

assistance through him or her. The

disability claim manager will also

provide you with information regarding

your right to representation, and he or

she will provide you with appropriate

referral sources for representation. The

disability claim manager may be either

a State agency employee or a Federal

employee. In some instances, the

disability claim manager may be

assisted by other individuals.

(2) In the single decisionmaker model,

the decisionmaker will make the

disability determination and may also

determine whether the other conditions

for entitlement to benefits based on

disability are met. The decisionmaker

will make the disability determination

after any appropriate consultation with

a medical or psychological consultant.

The medical or psychological consultant

will not be required to sign the

disability determination forms we use to

have the State agency certify the

determination of disability to us (see

§ 404.1615). However, before an initial

determination is made that a claimant is

not disabled in any case where there is

evidence which indicates the existence

of a mental impairment, the

decisionmaker will make every

reasonable effort to ensure that a

qualified psychiatrist or psychologist

has completed the medical portion of

the case review and any applicable

residual functional capacity assessment

pursuant to our existing procedures (see

§ 404.1617). In some instances the

decisionmaker may be the disability

claim manager described in paragraph

(b)(1) of this section. When the

decisionmaker is a State agency

employee, a team of individuals that

includes a Federal employee will

determine whether the other conditions

for entitlement to benefits are met.

(3) In the predecision interview

model, if the decisionmaker(s) finds that

the evidence in your file is insufficient

to make a fully favorable determination

or requires an initial determination

denying your claim, a predecision

notice will be mailed to you. The notice

will tell you that, before the

decisionmaker(s) makes an initial

determination about whether you are

disabled, you may request a predecision

interview with the decisionmaker(s).

The notice will also tell you that you

may submit additional evidence. You

must request a predecision interview

within 10 days after the date you receive

the predecision notice. You must also

submit any additional evidence within

10 days after you receive the

predecision notice. If you request a

predecision interview, the

decisionmaker(s) will conduct the

predecision interview in person, by

videoconference, or by telephone as the

decisionmaker(s) determines is

appropriate under the circumstances. If

you make a late request for a

predecision interview, or submit

additional evidence late, but show in

writing that you had good cause under

the standards in § 404.911 for missing

the deadline, the decisionmaker(s) will

extend the deadline. If you do not

request the predecision interview, or if

you do not appear for a scheduled

predecision interview and do not

submit additional evidence, or if you do

not respond to our attempts to

communicate with you, the

decisionmaker(s) will make an initial

determination based upon the evidence

in your file. If you identify additional

evidence during the predecision

interview, which was previously not

available, the decisionmaker(s) will

advise you to submit the evidence. If

you are unable to do so, the

decisionmaker(s) may assist you in

obtaining it. The decisionmaker(s) also

will advise you of the specific

timeframes you have for submitting any

additional evidence identified during

the predecision interview. If you have

no treating source(s) (see § 404.1502), or

your treating source(s) is unable or

unwilling to provide the necessary

evidence, or there is a conflict in the

evidence that cannot be resolved

through evidence from your treating

source(s), the decisionmaker(s) may

arrange a consultative examination or

resolve conflicts according to existing

procedures (see § 404.1519a). If you

attend the predecision interview, or do

not attend the predecision interview but

you submit additional evidence, the

decisionmaker(s) will make an initial

determination based on the evidence in

your file, including the additional

evidence you submit or the evidence

obtained as a result of the predecision

notice or interview, or both.

(4) In the reconsideration elimination

model, we will modify the disability

determination process by eliminating

the reconsideration step of the

administrative review process. If you

receive an initial determination on your

claim for benefits based on disability,

and you are dissatisfied with the

determination, we will notify you that

you may request a hearing before an

administrative law judge. If you request

a hearing before an administrative law

judge, we will apply our usual

procedures contained in subpart J of this

part.

PART 416—SUPPLEMENTAL

SECURITY INCOME FOR THE AGED,

BLIND, AND DISABLED

Subpart N is amended as follows:

1. The authority citation for subpart N

of part 416 continues to read as follows:
20028 Federal Register / Vol. 60, No. 78 / Monday, April 24, 1995 / Rules and Regulations

Authority: Secs. 1102, 1631, and 1633 of

the Social Security Act; 42 U.S.C. 1302, 1383,

and 1383b.

2. Section 416.1406 is revised to read

as follows:

§ 416.1406 Testing modifications to the

disability determination procedures.

(a) Applicability and scope.

Notwithstanding any other provision in

this part or part 422 of this chapter, we

are establishing the procedures set out

in this section to test modifications to

our disability determination process.

These modifications will enable us to

test, either individually or in one or

more combinations, the effect of: having

disability claim managers assume

primary responsibility for processing an

application for SSI payments based on

disability; providing persons who have

applied for benefits based on disability

with the opportunity for an interview

with a decisionmaker when the

decisionmaker finds that the evidence

in the file is insufficient to make a fully

favorable determination or requires an

initial determination denying the claim;

having a single decisionmaker make the

initial determination with assistance

from medical consultants, where

appropriate; and eliminating the

reconsideration step in the

administrative review process and

having a claimant who is dissatisfied

with the initial determination request a

hearing before an administrative law

judge. The model procedures we test

will be designed to provide us with

information regarding the effect of these

procedural modifications and enable us

to decide whether and to what degree

the disability determination process

would be improved if they were

implemented on a national level.

(b) Procedures for cases included in

the tests. Prior to commencing each test

or group of tests in selected site(s), we

will publish a notice in the Federal

Register. The notice will describe which

model or combinations of models we

intend to test, where the specific test

site(s) will be, and the duration of the

test(s). The individuals who participate

in the test(s) will be randomly assigned

to a test group in each site where the

tests are conducted. Paragraph (b) (1)

through (4) of this section lists

descriptions of each model.

(1) In the disability claim manager

model, when you file an application for

SSI payments based on disability, a

disability claim manager will assume

primary responsibility for the

processing of your claim. The disability

claim manager will be the focal point for

your contacts with us during the claims

intake process and until an initial

determination on your claim is made.

The disability claim manager will

explain the SSI disability program to

you, including the definition of

disability and how we determine

whether you meet all the requirements

for SSI payments based on disability.

The disability claim manager will

explain what you will be asked to do

throughout the claims process and how

you can obtain information or assistance

through him or her. The disability claim

manager will also provide you with

information regarding your right to

representation, and he or she will

provide you with appropriate referral

sources for representation. The

disability claim manager may be either

a State agency employee or a Federal

employee. In some instances, the

disability claim manager may be

assisted by other individuals.

(2) In the single decisionmaker model,

the decisionmaker will make the

disability determination and may also

determine whether the other conditions

of eligibility for SSI payments based on

disability are met. The decisionmaker

will make the disability determination

after any appropriate consultation with

a medical or psychological consultant.

The medical or psychological consultant

will not be required to sign the

disability determination forms we use to

have the State agency certify the

determination of disability to us (see

§ 416.1015). However, before an initial

determination is made that a claimant is

not disabled in any case where there is

evidence which indicates the existence

of a mental impairment, the

decisionmaker will make every

reasonable effort to ensure that a

qualified psychiatrist or psychologist

has completed the medical portion of

the case review and any applicable

residual functional capacity assessment

pursuant to our existing procedures (see

§ 416.1017). Similarly, in making an

initial determination with respect to the

disability of a child under age 18

claiming SSI payments based on

disability, the decisionmaker will make

reasonable efforts to ensure that a

qualified pediatrician, or other

individual who specializes in a field of

medicine appropriate to the child’s

impairment(s), evaluates the claim of

such child (see § 416.903(f)). In some

instances the decisionmaker may be the

disability claim manager described in

paragraph (b)(1) of this section. When

the decisionmaker is a State agency

employee, a team of individuals that

includes a Federal employee will

determine whether the other conditions

of eligibility for SSI payments are met.

(3) In the predecision interview

model, if the decisionmaker(s) finds that

the evidence in your file is insufficient

to make a fully favorable determination

or requires an initial determination

denying your claim, a predecision

notice will be mailed to you. The notice

will tell you that, before the

decisionmaker(s) makes an initial

determination about whether you are

disabled, you may request a predecision

interview with the decisionmaker(s).

The notice will also tell you that you

may also submit additional evidence.

You must request a predecision

interview within 10 days after the date

you receive the predecision notice. You

must also submit any additional

evidence within 10 days after the date

you receive the predecision notice. If

you request a predecision interview, the

decisionmaker(s) will conduct the

predecision interview in person, by

videoconference, or by telephone as the

decisionmaker(s) determines is

appropriate under the circumstances. If

you make a late request for a

predecision interview, or submit

additional evidence late, but show in

writing that you had good cause under

the standards in § 416.1411 for missing

the deadline, the decisionmaker(s) will

extend the deadline. If you do not

request the predecision interview or if

you do not appear for a scheduled

predecision interview and do not

submit additional evidence, or if you do

not respond to our attempts to

communicate with you, the

decisionmaker(s) will make an initial

determination based upon the evidence

in your file. If you identify additional

evidence during the predecision

interview, which was previously not

available, the decisionmaker(s) will

advise you to submit the evidence. If

you are unable to do so, the

decisionmaker(s) may assist you in

obtaining it. The decisionmaker(s) also

will advise you of the specific

timeframes you have for submitting any

additional evidence identified during

the predecision interview. If you have

no treating source(s) (see § 416.902), or

your treating source(s) is unable or

unwilling to provide the necessary

evidence, or there is a conflict in the

evidence that cannot be resolved

through evidence from your treating

source(s), the decisionmaker(s) may

arrange a consultative examination or

resolve conflicts according to existing

procedures (see § 416.919a). If you

attend the predecision interview, or do

not attend the predecision interview but

you submit additional evidence, the

decisionmaker(s) will make an initial

determination based on the evidence in

your file, including the additional

evidence you submit or the evidence
Federal Register / Vol. 60, No. 78 / Monday, April 24, 1995 / Rules and Regulations 20029

obtained as a result of the predecision

notice or interview, or both.

(4) In the reconsideration elimination

model, we will modify the disability

determination process by eliminating

the reconsideration step of the

administrative review process. If you

receive an initial determination on your

claim for SSI payments based on

disability, and you are dissatisfied with

the determination, we will notify you

that you may request a hearing before an

administrative law judge. If you request

a hearing before an administrative law

judge, we will apply our usual

procedures contained in subpart N of

this part.

[FR Doc. 95–9897 Filed 4–21–95; 8:45 am]

BILLING CODE 4190–29–P

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Parts 83 and 84

[DoD Directive 5500.7 and DoD 5500.7–R;

0790–AG12, and 0790–AF83]

Standards of Conduct and Joint Ethics

Regulation

AGENCY: Office of the Secretary of

Defense, DoD.

ACTION: Final rule and request for

comments.

SUMMARY: The changes to these parts,

concerning standards of conduct and

joint ethics, correct typographical errors

and update the regulations in

accordance with changes to related

statutes. The changes are intended to

keep these parts current.

DATES: These changes are effective

November 2, 1994. Comments must be

received no later than June 23, 1995.

ADDRESSES: Forward comments to DoD

Standards of Conduct Office, Office of

General Counsel, 1600 Defense

Pentagon, Washington, DC 20301–1600.

FOR FURTHER INFORMATION CONTACT:

Randi Elizabeth DuFresne, DoD

Standards of Conduct Office, (703) 697–

5305, FAX (703) 697–1640.

SUPPLEMENTARY INFORMATION: On March

21, 1994, the Department of Defense

published a final rule and request for

comments on Standards of Conduct and

Joint Ethics Regulation. See 59 FR 13212

and 13213. Two public comments were

received. Both expressed appreciation of

the regulation and required no further

action.

Executive Order 12866

It has been determined that these are

not significant changes as defined under

section 3(f)(1) through 3(f)(4) of

Executive Order 12866.

Regulatory Flexibility Act

It has been certified that these

changes are not subject to the

Regulatory Flexibility Act (5 U.S.C.

chapter 6) because they do not have a

significant economic impact on a

substantial number of small entities.

The changes affects only DoD

employees and are to update existing

regulations in keeping with changes to

related statutes.

Paperwork Reduction Act

It has been certified that these

changes impose no reporting or record

keeping requirements under the

Paperwork Reduction Act of 1980 (44

U.S.C. 3501–3502).

List of Subjects in 32 CFR Parts 83 and

84

Conflicts of interest, Government

procurement.

Accordingly, 32 CFR parts 83 and 84

are amended as follows:

PART 83—[AMENDED]

1. The authority citation for part 83

continues to read as follows:

Authority: 5 U.S.C., 301, 7301, 7351, 7353;

5 U.S.C. App. (Ethics in Government Act of

1978); E.O. 12674, 54 FR 15159, 3 CFR, 1989

Comp., p. 215 as modified by E.O. 12731, 55

FR 42547, 3 CFR, 1990 Comp., p. 306; 5 CFR

part 2635.

§ 83.1 [Amended]

2. Section 83.1(c) is amended by

removing ‘‘August 1989.’’

PART 84—[AMENDED]

1. The authority citation for part 84

continues to read as follows:

Authority: 5 U.S.C., 301, 7301, 7351, 7353;

5 U.S.C. App. (Ethics in Government Act of

1978); E.O. 12674, 54 FR 15159, 3 CFR, 1989

Comp., p. 215 as modified by E.O. 12731, 55

FR 42547, 3 CFR, 1990 Comp., p. 306; 5 CFR

part 2635.

§ 84.4 [Amended]

2. Section 84.4 is amended in

paragraphs (a)(1) and (a)(4) after the

acronyms ‘‘DAEO’’ by adding ‘‘or

designee’’.

3. Section 84.7 is amended in

paragraph (c)(1) by removing ‘‘735.208’’

and adding in its place ‘‘735.201’’, in

paragraph (c)(3) by removing ‘‘406’’

adding in its place ‘‘40b’’; and by

revising paragraph (c)(1)(ii), by

removing the period at the end of

paragraph (c)(1)(iii) and adding ‘‘;or’’

and by adding paragraph (c)(1)(iv) to

read as follows:

§ 84.7 DoD guidance.

* * * * *

(c) * * *

(1) * * *

(ii) Activities by organizations

composed primarily of DoD employees

or their dependents for the benefit of

welfare funds for their own members or

for the benefit of other DoD employees

or their dependents, subject to the

limitations of local law and of § 84.9(k)

and (l), when approved by the Head of

the DoD Component or designee;

* * * * *

(iv) Purchases of lottery tickets

authorized by any State from blind

vendors licensed to operate vending

facilities in accordance with 20 U.S.C.

107a(5).

* * * * *

4. Section 84.9 is amended in

paragraph (b) after the word ‘‘entities’’

by removing the word ‘‘where’’ and

adding in its place ‘‘when appointed by

the head of the DoD Component

command or organization who

determines’’; in paragraph (k)(1)(vi) after

the word ‘‘composed’’ by adding

‘‘primarily’’; in paragraph (k)(2) by

revising ‘‘paragraph (d)’’ to read

‘‘paragraph (f)’’; in paragraph (l)(1)

introductory text by revising ‘‘DoD

equipment’’ to read ‘‘DoD facilities and

equipment’’; in paragraph (l)(1)(ii) after

the word ‘‘event’’ by adding ‘‘(OPM

generally has no objection to support of

events that do not specifically target

Federal employees for fundraising)’’;

and by revising paragraphs (l)(1)(vi),

(l)(1)(vii) and (m) introductory text to

read as follows:

§ 84.9 Official participation in non-Federal

entities.

* * * * *

(l) * * *

(1) * * *

(vi) The DoD Component command or

organization is able and willing to

provide the same support to comparable

events that meet the criteria of this

subsection and are sponsored by other

similar non-Federal entities;

* * * * *

(viii) Except for a charitable

fundraising event that meets all other

criteria for DoD participation, no

admission fee (beyond what will cover

the reasonable costs of sponsoring the

event) is charged for the event, no

admission fee (beyond what will cover

the reasonable costs of sponsoring the

event) is charged for the portion of the

event supported by the DoD, or DoD

support to the event is incidental to the

entire event in accordance with public

affairs guidance.

* * * * *