81 FR 13439 - Social Security Ruling, SSR 16-2p; Titles II and XVI: Evaluation of Claims Involving Similar Fault in the Providing of Evidence
SOCIAL SECURITY ADMINISTRATION Federal Register Volume 81, Issue 49 (March 14, 2016)
Federal Register Volume 81, Issue 49 (March 14, 2016)
| Page Range | 13439-13441 | |
| FR Document | 2016-05660 |
[Federal Register Volume 81, Number 49 (Monday, March 14, 2016)] [Notices] [Pages 13439-13441] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-05660] ----------------------------------------------------------------------- SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2015-0038] Social Security Ruling, SSR 16-2p; Titles II and XVI: Evaluation of Claims Involving Similar Fault in the Providing of Evidence AGENCY: Social Security Administration. ACTION: Notice of Social Security Ruling (SSR). ----------------------------------------------------------------------- SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of Social Security gives notice of SSR 16-2p. This Ruling supersedes and replaces previously published SSR 00-2p. It provides the definition of fraud, and clarifies the definitions of knowingly and preponderance of the evidence. The Ruling also clarifies that we may find that any individual or entity has committed fraud or similar fault, and that we may disregard evidence submitted by any individual or entity that we find has committed fraud or similar fault. In addition, the Ruling provides examples of such individuals and entities. DATES: Effective Date: March 14, 2016. FOR FURTHER INFORMATION CONTACT: Dan O'Brien, Director of Office of Vocational Evaluation and Process Policy in the Office of Disability Policy, Social Security Administration, 6401 Security Boulevard, Baltimore, MD 21235-6401, (410) 597-1632 or TTY 410-966-5609, for information about this notice. For information on eligibility or filing for benefits, call our national toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or visit our Internet site, Social Security Online, at http://www.socialsecurity.gov. SUPPLEMENTARY INFORMATION: Although we are not required to do so pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this SSR in accordance with 20 CFR 402.35(b)(1). Through SSRs, we convey to the public precedential decisions relating to the Federal old-age, survivors, disability, supplemental security income, and special veterans benefits programs. We may base SSRs on determinations or decisions made at all levels of administrative adjudication, Federal court decisions, Commissioner's decisions, opinions of the Office of the General Counsel, or other interpretations of the law and regulations. Although SSRs do not have the same force and effect as statutes or regulations, they are binding on all components of the Social Security Administration, in accordance with 20 CFR 402.35(b)(1), and are binding as precedents in adjudicating cases. This SSR will remain in effect until we publish a notice in the Federal Register that rescinds it, or we publish a new SSR that replaces or modifies it. (Catalog of Federal Domestic Assistance, Programs Nos. 96.001, Social Security--Disability Insurance; 96.002, Social Security-- Retirement Insurance; 96.004, Social Security--Survivors Insurance; 96.006--Supplemental Security Income.) [[Page 13440]] Dated: March 7, 2016. Carolyn W. Colvin, Acting Commissioner of Social Security. POLICY INTERPRETATION RULING Social Security Ruling, SSR 16-2p: TITLES II AND XVI: EVALUATION OF CLAIMS INVOLVING THE ISSUE OF SIMILAR FAULT IN THE PROVIDING OF EVIDENCE This SSR rescinds and replaces SSR 00-2p: ``TITLES II AND XVI: EVALUATION OF CLAIMS INVOLVING THE ISSUE OF ``SIMILAR FAULT'' IN THE PROVIDING OF EVIDENCE.'' PURPOSE: To explain the rules that govern the evaluation and adjudication of claims when there is reason to believe similar fault was involved in the providing of evidence in support of the claim. CITATIONS: Sections 205(u) and 1631(e)(7) of the Social Security Act, 42 U.S.C. 405(u), 1383(e)(7), as amended; 20 CFR 404.704, 404.708, 404.1512, 404.1520, 416.912, 416.920, 416.924, and 422.130(b). INTRODUCTION: The Social Security Independence and Program Improvements Act of 1994, Public Law 103-296, amended the Social Security Act (Act) to add provisions addressing fraud or similar fault. These amendments to sections 205 and 1631 of the Act provide that we must immediately redetermine an individual's entitlement to monthly insurance benefits under title II or eligibility for benefits under title XVI if there is reason to believe that fraud or similar fault was involved in the individual's application for such benefits. This statute further provides that, when we redetermine entitlement or eligibility, or when we make an initial determination of entitlement or eligibility, we ``shall disregard any evidence if there is reason to believe that fraud or similar fault was involved in the providing of such evidence.'' If, after redetermining entitlement to or eligibility for benefits, we determine that without the disregarded evidence, the evidence does not support entitlement or eligibility, we may terminate such entitlement or eligibility and may treat benefits paid based on such evidence as overpayments. This Ruling sets forth the standards we and State agency adjudicators will apply at all levels of the administrative review process in determining whether there is reason to believe that similar fault was involved in providing evidence in connection with a claim for benefits. It also provides guidance for the evaluation of such claims when there is reason to believe that similar fault was involved. It applies to all claims for benefits under title II and title XVI of the Act; e.g., claims for old-age and survivors benefits and disability benefits under title II of the Act, and claims for Supplemental Security Income benefits for the aged, blind, and disabled under title XVI of the Act. This Ruling does not replace or limit other appropriate standards and criteria for development and evaluation of claims. There may be instances in which evidence will not be disregarded under the statutory provisions discussed in this Ruling, but nevertheless, factors may exist that justify giving the evidence in question less credence than other evidence. POLICY INTERPRETATION: A. General 1. Sections 205(u) and 1631(e)(7) of the Act provide that we must disregard evidence if there is reason to believe that fraud or similar fault was involved in the providing of that evidence. These sections explain that similar fault is involved if: ``(A) an incorrect or incomplete statement that is material to the determination is knowingly made; or (B) information that is material to the determination is knowingly concealed.'' 2. We may find that any individual or entity whose actions affect an individual's application for monthly benefits, has committed fraud or similar fault. We may disregard evidence based on similar fault of a claimant, a recipient of benefits, or any other individual or entity connected with the claim. Examples of any individual or entity include a claimant, beneficiary, auxiliary, recipient, spouse, representative, medical source, translator, interpreter, and representative payee. Sections 205(u) or 1631(e)(7) of the Act do not require that the individual or entity who committed fraud or similar fault, or the individual or entity providing the evidence that involves fraud or similar fault, have a direct relationship to or act on behalf of the claimant, beneficiary, or recipient, or directly or indirectly benefit from the fraud or similar fault. 3. A finding of similar fault can be made only if there is reason to believe that, based on a preponderance of the evidence, the person committing the fault knew that the evidence provided was false or incomplete. We cannot base a finding of similar fault on speculation or suspicion. 4. A finding of similar fault is sufficient to take the administrative actions described in this Ruling. Although a finding of ``fraud'' made as part of a criminal prosecution can serve as a basis for the administrative actions described below, such a finding is not required. 5. A finding of similar fault concerning a material fact may constitute evidence to be considered in determining whether there is reason to believe that similar fault was involved with respect to other evidence provided by the same source, and may justify disregarding other evidence from that source. Also, the evidence relied on to make a finding of similar fault in one claim may be considered in deciding whether there is similar fault in another claim or in deciding whether to give less weight to evidence in another claim. 6. A finding of similar fault does not constitute complete adjudicative action in any claim. A person may still be found entitled to, or eligible for, monthly benefits despite the fact that some evidence in the case record has been disregarded based on similar fault. B. Definitions 1. Fraud. Fraud exists when a person, with the intent to defraud, either makes or causes to be made, a false statement or misrepresentation of a material fact for use in determining rights under the Social Security Act; or conceals or fails to disclose a material fact for use in determining rights under the Social Security Act. 2. Similar Fault. As defined in section 205(u)(2) and 1631(e)(7)(B) of the Act, similar fault is involved with respect to a determination if: ``(A) an incorrect or incomplete statement that is material to the determination is knowingly made; or (B) information that is material to the determination is knowingly concealed.'' 3. Material. This term describes a statement or information, or an omission from a statement or information that could influence us in determining entitlement to benefits under title II or eligibility for benefits under title XVI of the Act. 4. Knowingly. This term describes a person's awareness or understanding regarding the correctness or completeness of the information he or she provides us, or the materiality of the information he or she conceals from us. 5. Preponderance of Evidence. This term means such relevant evidence that as a whole shows that the existence of a fact to be proven is more likely than not. Preponderance is established by that piece or body of evidence that, when considered, produces the stronger impression and is more convincing as to its truth when weighed against the evidence in opposition. Thus, preponderance does not require that a [[Page 13441]] certain number of pieces of evidence (e.g., five or six) must be present. It is possible that just one piece of evidence may be so convincing that it outweighs more than one piece of evidence in opposition. C. Development and Evaluation Adjudicators at all levels of the administrative review process are responsible for taking all appropriate steps to resolve similar fault issues in accordance with the standards in this Ruling. Adjudicators must adhere to existing due process and confidentiality requirements during the process of resolving similar fault issues. In making determinations about whether there is similar fault, all adjudicators must: 1. Consider all evidence in the case record before determining whether specific evidence may be disregarded. 2. Apply the preponderance of evidence standard, as defined in this Ruling. 3. Fully document the record with the evidence that was the basis for the finding that, based on a preponderance of the evidence, there is reason to believe that similar fault was involved in providing the evidence that is being disregarded. D. Notice of Determination or Decision In determinations or decisions that involve a finding of similar fault and disregarding evidence, the notice of determination or decision must: 1. Explain the applicable provision of the Act that allows the adjudicator to disregard particular evidence due to a similar fault finding. 2. Identify the documents or other evidence that is being disregarded. 3. Provide a discussion of the evidence that supports a finding to disregard evidence. The discussion must explain that, in accordance with the law, the evidence identified cannot be used as evidence in the claim because, after considering all the information in the case record, the adjudicator has reason to believe that similar fault was involved in providing the evidence and it must be disregarded. Again, a similar fault finding can be made only if there is reason to believe, based on a preponderance of the evidence, the person knew that the evidence provided was false or incomplete. A similar fault finding cannot be based on speculation or suspicion. 4. Provide a determination or decision based on an evaluation of the remaining evidence in accordance with other rules and procedures. A similar fault finding does not constitute complete adjudicative action in any claim. A person may still be found entitled to, or eligible for, monthly benefits despite the fact that some evidence in the case record has been disregarded based on similar fault. For example, a person may be found to be under a disability based on impairments that are established by evidence that is not disregarded because of similar fault. 5. Include standard appeal language. EFFECTIVE DATE: This SSR is effective on March 14, 2016. CROSS-REFERENCES: SSR 85-23, ``Title XVI: Reopening Supplemental Security Income Determinations at Any Time for Similar Fault.'' [FR Doc. 2016-05660 Filed 3-11-16; 8:45 am] BILLING CODE 4191-02-P
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determination. While regulations allow Further, our regulations provide that clarifies the definitions of knowingly
the ALJ to extend the time for requesting a ‘‘decision’’ means ‘‘the decision made and preponderance of the evidence. The
a hearing when a claimant has ‘‘good by the administrative law judge or the Ruling also clarifies that we may find
cause’’ for the late request, the ALJ ruled Appeals Council.’’ 20 CFR 404.901, that any individual or entity has
that Ms. Boley lacked good cause 416.1401. Of direct relevance here, the committed fraud or similar fault, and
because she had received the regulations distinguish between an that we may disregard evidence
reconsideration notice and could have ALJ’s ‘‘decision’’ and an ALJ’s dismissal submitted by any individual or entity
filed a hearing request herself. Ms. of a claimant’s request for a hearing. An that we find has committed fraud or
Boley filed a timely request for review ALJ’s decision is subject to review by similar fault. In addition, the Ruling
of the ALJ’s dismissal order with the the agency’s AC and ultimately may be provides examples of such individuals
AC. When the AC denied her request for subject to judicial review. 20 CFR and entities.
review of the ALJ’s dismissal order, Ms. 404.955, 416.1455. An ALJ’s dismissal
Boley sought judicial review. of a hearing request, 20 CFR 404.957, DATES: Effective Date: March 14, 2016.
HOLDING: The United States Court of 416.1457, on the other hand, is not a FOR FURTHER INFORMATION CONTACT: Dan
Appeals for the Seventh Circuit ‘‘decision’’ within the meaning of
O’Brien, Director of Office of Vocational
concluded that a claimant for Social section 205(g) of the Act. Rather, it is
Evaluation and Process Policy in the
Security benefits may obtain judicial binding unless vacated by an ALJ or the
AC, and the dismissal of a hearing Office of Disability Policy, Social
review of an ALJ’s dismissal order
finding no good cause for a late hearing request is not subject to judicial review. Security Administration, 6401 Security
request after exhausting all available 20 CFR 404.959, 416.1459. Boulevard, Baltimore, MD 21235–6401,
administrative remedies. EXPLANATION OF HOW WE WILL (410) 597–1632 or TTY 410–966–5609,
STATEMENT AS TO HOW BOLEY APPLY THE BOLEY DECISION WITHIN for information about this notice. For
DIFFERS FROM THE AGENCY’S THE CIRCUIT: information on eligibility or filing for
POLICY: This Ruling applies only to claims in benefits, call our national toll-free
Unlike the holding in Boley, our which all the following criteria are met: number, 1–800–772–1213 or TTY 1–
policy provides that an ALJ’s order 1. The claimant did not timely request 800–325–0778, or visit our Internet site,
finding no good cause for a late hearing a hearing before an ALJ; Social Security Online, at http://
request and dismissing the request as 2. The ALJ dismissed the claimant’s www.socialsecurity.gov.
untimely is not subject to judicial request for a hearing;
3. The basis for the ALJ’s dismissal of SUPPLEMENTARY INFORMATION: Although
review. Section 205(g) of the Social
the hearing request was that the we are not required to do so pursuant
Security Act, 42 U.S.C. 405(g), ‘‘clearly
claimant failed to show good cause for to 5 U.S.C. 552(a)(1) and (a)(2), we are
limits judicial review to a particular
untimely filing of the hearing request; publishing this SSR in accordance with
type of agency action, a ‘final decision
4. The claimant timely filed a request 20 CFR 402.35(b)(1).
of the [Commissioner of Social Security]
for the AC to review the ALJ’s dismissal
made after a hearing.’ ’’ Califano v. Through SSRs, we convey to the
of the hearing request;
Sanders, 430 U.S. 99, 108 (1977). The 5. The AC denied the claimant’s public precedential decisions relating to
Supreme Court has also recognized that request for review; and the Federal old-age, survivors,
‘‘the term ‘final decision’ is left 6. The claimant resided in Indiana, disability, supplemental security
undefined by the Act and its meaning is Illinois, or Wisconsin at the time the AC income, and special veterans benefits
to be fleshed out by the denied review. programs. We may base SSRs on
[Commissioner’s] regulations.’’ If a case meets these criteria, we will determinations or decisions made at all
Weinberger v. Salfi, 422 U.S. 749, 751 send notice explaining that the claimant levels of administrative adjudication,
(1975). may appeal the dismissal to the Federal Federal court decisions, Commissioner’s
Under our regulations, the claimant district court for the judicial district in decisions, opinions of the Office of the
must first obtain an ‘‘initial Illinois, Indiana, or Wisconsin in which General Counsel, or other
determination’’ and then complete an the claimant resides. interpretations of the law and
administrative review process regulations.
[FR Doc. 2016–05663 Filed 3–11–16; 8:45 am]
consisting of several steps, ‘‘which
usually must be requested within BILLING CODE 4191–02–P Although SSRs do not have the same
certain time periods,’’ 20 CFR force and effect as statutes or
404.900(a), 416.1400(a), before obtaining regulations, they are binding on all
SOCIAL SECURITY ADMINISTRATION
a judicially reviewable ‘‘decision.’’ Not components of the Social Security
all agency actions constitute ‘‘initial [Docket No. SSA–2015–0038] Administration, in accordance with 20
determinations’’ subject to the CFR 402.35(b)(1), and are binding as
administrative review process and, Social Security Ruling, SSR 16–2p; precedents in adjudicating cases.
ultimately, judicial review. 20 CFR Titles II and XVI: Evaluation of Claims
Involving Similar Fault in the Providing This SSR will remain in effect until
404.903, 416.1403(a) (identifying we publish a notice in the Federal
numerous administrative actions that of Evidence
Register that rescinds it, or we publish
are not initial determinations). For AGENCY: Social Security Administration. a new SSR that replaces or modifies it.
example, although we will extend the ACTION: Notice of Social Security Ruling
time to seek a hearing upon a showing (Catalog of Federal Domestic Assistance,
jstallworth on DSK7TPTVN1PROD with NOTICES
(SSR).
of good cause, 20 CFR 404.933(c), Programs Nos. 96.001, Social Security—
416.1433(c), an administrative action SUMMARY: In accordance with 20 CFR Disability Insurance; 96.002, Social
denying a request to extend a time 402.35(b)(1), the Commissioner of Social Security—Retirement Insurance; 96.004,
period is not an initial determination Security gives notice of SSR 16–2p. This Social Security—Survivors Insurance;
subject to the administrative review Ruling supersedes and replaces 96.006—Supplemental Security Income.)
process or judicial review. 20 CFR previously published SSR 00–2p. It
404.903(j), 416.1403(a)(8). provides the definition of fraud, and
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![Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices 13441
certain number of pieces of evidence adjudicative action in any claim. A DEPARTMENT OF STATE
(e.g., five or six) must be present. It is person may still be found entitled to, or
possible that just one piece of evidence eligible for, monthly benefits despite the [Public Notice 9474]
may be so convincing that it outweighs fact that some evidence in the case
more than one piece of evidence in record has been disregarded based on In the Matter of the Designation of
opposition. similar fault. For example, a person may Abdul Saboor, aka Engineer Saboor,
be found to be under a disability based aka Abdul Saboor Nasratyar as a
C. Development and Evaluation Specially Designated Global Terrorist
on impairments that are established by
Adjudicators at all levels of the
evidence that is not disregarded because Acting under the authority of and in
administrative review process are
of similar fault. accordance with section 1(b) of
responsible for taking all appropriate
steps to resolve similar fault issues in 5. Include standard appeal language. Executive Order 13224 of September 23,
accordance with the standards in this 2001, as amended by Executive Order
EFFECTIVE DATE: This SSR is 13268 of July 2, 2002, and Executive
Ruling. Adjudicators must adhere to effective on March 14, 2016.
existing due process and confidentiality Order 13284 of January 23, 2003, I
CROSS-REFERENCES: SSR 85–23, hereby determine that the individual
requirements during the process of
resolving similar fault issues. ‘‘Title XVI: Reopening Supplemental known as Abdul Saboor, also known as
In making determinations about Security Income Determinations at Any Engineer Saboor, also known as Abdul
whether there is similar fault, all Time for Similar Fault.’’ Saboor Nasratyar committed, or poses a
adjudicators must: [FR Doc. 2016–05660 Filed 3–11–16; 8:45 am] significant risk of committing, acts of
1. Consider all evidence in the case terrorism that threaten the security of
BILLING CODE 4191–02–P
record before determining whether U.S. nationals or the national security,
specific evidence may be disregarded. foreign policy, or economy of the United
2. Apply the preponderance of States.
evidence standard, as defined in this DEPARTMENT OF STATE Consistent with the determination in
Ruling. section 10 of Executive Order 13224 that
3. Fully document the record with the ‘‘prior notice to persons determined to
[Public Notice: 9476] be subject to the Order who might have
evidence that was the basis for the
finding that, based on a preponderance a constitutional presence in the United
Foreign Affairs Policy Board Meeting States would render ineffectual the
of the evidence, there is reason to Notice; Closed Meeting
believe that similar fault was involved blocking and other measures authorized
in providing the evidence that is being in the Order because of the ability to
In accordance with the Federal
disregarded. transfer funds instantaneously,’’ I
Advisory Committee Act, 5 U.S.C. App., determine that no prior notice needs to
D. Notice of Determination or Decision the Department of State announces a be provided to any person subject to this
In determinations or decisions that meeting of the Foreign Affairs Policy determination who might have a
involve a finding of similar fault and Board to take place on March 28, 2016, constitutional presence in the United
disregarding evidence, the notice of at the Department of State, Washington, States, because to do so would render
determination or decision must: DC. ineffectual the measures authorized in
1. Explain the applicable provision of The Foreign Affairs Policy Board the Order.
the Act that allows the adjudicator to reviews and assesses: (1) Global threats This notice shall be published in the
disregard particular evidence due to a and opportunities; (2) trends that Federal Register.
similar fault finding. implicate core national security Dated: March 4, 2016.
2. Identify the documents or other interests; (3) tools and capacities of the John F. Kerry,
evidence that is being disregarded. civilian foreign affairs agencies; and (4)
3. Provide a discussion of the Secretary of State.
priorities and strategic frameworks for [FR Doc. 2016–05673 Filed 3–11–16; 8:45 am]
evidence that supports a finding to
U.S. foreign policy. Pursuant to section
disregard evidence. The discussion BILLING CODE 4710–AD–P
10(d) of the Federal Advisory
must explain that, in accordance with
the law, the evidence identified cannot Committee Act, 5 U.S.C. App 10(d), and
be used as evidence in the claim 5 U.S.C. 552b(c)(1), it has been DEPARTMENT OF STATE
because, after considering all the determined that this meeting will be
closed to the public as the Board will be [Public Notice: 9459]
information in the case record, the
adjudicator has reason to believe that reviewing and discussing matters
properly classified in accordance with Notice of Meeting of the Cultural
similar fault was involved in providing Property Advisory Committee
the evidence and it must be disregarded. Executive Order 13526.
Again, a similar fault finding can be For more information, contact Adam There will be a meeting of the
made only if there is reason to believe, Lusin at (202) 647–4967. Cultural Property Advisory Committee
based on a preponderance of the (‘‘the Committee’’) May 24–26, 2016, at
Dated: March 7, 2016. the United States Department of State,
evidence, the person knew that the
evidence provided was false or Adam Lusin, Harry S Truman Building, 2201 C Street
incomplete. A similar fault finding Designated Federal Officer. NW., and State Annex 5, 2200 C Street
jstallworth on DSK7TPTVN1PROD with NOTICES
cannot be based on speculation or [FR Doc. 2016–05676 Filed 3–11–16; 8:45 am] NW., Washington, DC. The Committee’s
suspicion. BILLING CODE 4710–05–P responsibilities are carried out in
4. Provide a determination or decision accordance with provisions of the
based on an evaluation of the remaining Convention on Cultural Property
evidence in accordance with other rules Implementation Act (19 U.S.C. 2601 et
and procedures. A similar fault finding seq.) (‘‘the Act’’). A portion of this
does not constitute complete meeting will be closed to the public
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Document Created: 2016-03-12 01:00:17
Document Modified: 2016-03-12 01:00:17
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice of Social Security Ruling (SSR). | |
| Contact | Dan O'Brien, Director of Office of Vocational Evaluation and Process Policy in the Office of Disability Policy, Social Security Administration, 6401 Security Boulevard, Baltimore, MD 21235-6401, (410) 597-1632 or TTY 410-966-5609, for information about this notice. For information on eligibility or filing for benefits, call our national toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or visit our Internet site, Social Security Online, at http://www.socialsecurity.gov. | |
| FR Citation | 81 FR 13439 |
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