Social Security Ruling, SSR 09-3p.; Title XVI: Determining Childhood Disability-The Functional Equivalence Domain of “Acquiring and Using Information”, 7511-7515 [E9-3379]
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Received—20 CFR 404.1520(b),
404.1571–.1576, 404.1584–.1593 and
416.971–.976 —0960–0059. SSA’s field
offices use Form SSA–821–BK to obtain
work information from recipients during
the continuing disability review
process, and whenever a work issue
arises in SSI claims. SSA’s processing
centers and Office of Disability and
International Operations use the form to
obtain post-adjudicative work issues
from recipients’ by mail. The primary
purpose of this form is to collect
recipient employment information in
order to determine whether or not
recipients have worked in employment
after becoming disabled and, if so,
whether the work is substantial gainful
activity. SSA will review and evaluate
the data to determine if the recipient
continues to meet the disability
requirements of the law. The
respondents are Social Security
disability applicants, beneficiaries, and
SSI applicants. Note: SSA listed this
information collection as an extension
of an OMB-approved information
collection in the 60-Day Federal
Register Notice published on December
11, 2008; it is a revision of an OMBapproved information collection.
Type of Request: Revision of an OMBapproved information collection.
Number of Respondents: 300,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 50,000
hours.
8. Application for Supplemental
Security Income —20 CFR 416.305–
416.335, Subpart C—0960–0444. Form
SSA–8001–BK collects information SSA
uses to determine an applicant’s
eligibility for SSI, and the amount of SSI
payments. SSA employees secure this
information during interviews
conducted with members of the public
who wish to file for SSI payments. SSA
uses this form for two purposes: (1) To
establish a disability claim, but defer the
complete development of non-medical
issues until SSA approves the disability,
or (2) to formally deny SSI payments for
non-medical reasons when information
provided by the applicant results in
ineligibility. The respondents are
applicants for SSI payments.
Note: SSA listed this information
collection as an extension of an OMBapproved information collection in the 60Day Federal Register Notice published on
December 11, 2008; it is a revision of an
OMB-approved information collection.
Type of Request: Revision of an OMBapproved information collection.
Number of minutes to complete form
Number of respondents
Form type
Burden hours
711,135
237,045
19,351
15
14
18
177,784
55,311
5,805
Totals ..............................................................................................................................
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MSSIC ....................................................................................................................................
MSSIC/Signature Proxy .........................................................................................................
Paper .....................................................................................................................................
967,531
..........................
238,900
9. Medicaid Use Report—20 CFR
416.268—0960–0267. SSA uses the
information required by this regulation
to determine if an individual is entitled
to special SSI payments and,
consequently, to Medicaid benefits. The
respondents are SSI recipients for whom
SSA has stopped payments based on
earnings.
Type of Request: Extension of an
OMB-approved information collection.
Number of Respondents: 60,000.
Frequency of Response: 1.
Average Burden Per Response: 3
minutes.
Estimated Annual Burden: 3,000
hours.
10. Claimant’s Recent Medical
Treatment— 20 CFR 404.1512 and
416.912—0960–0292. Each claimant
who requests a hearing before an ALJ
has a right to such a hearing once the
Disability Determination Service (DDS),
at the reconsideration level, has denied
the claim. For the hearing, SSA requests
the claimant complete and return the
HA–4631 if the claimant’s file does not
reflect a current, complete medical
history as the claimant proceeds
through the appeals process. ALJs must
obtain the information to update and
complete the record and to verify the
accuracy of the information. It is by this
process ALJs can ascertain whether the
claimant’s situation has changed. The
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ALJ and hearing office staff use the
response to make arrangements for
consultative examination(s) and the
attendance of an expert witness(es) at
the hearing, if appropriate. During the
hearing, the ALJ offers any completed
questionnaires as exhibits and may use
them to refresh the claimant’s memory,
and to inquire into the matters at issue.
The respondents are claimants
requesting hearings on entitlement to
OASDI benefits or SSI payments.
Type of Request: Extension of an
OMB-Approved Information Collection
Number of Respondents: 350,000.
Frequency of Response: 1.
Average Burden Per Response: 10
minutes.
Estimated Annual Burden: 58,333
hours.
Dated: February 9, 2009.
John Biles,
Reports Clearance Officer, Center for Reports
Clearance, Social Security Administration.
[FR Doc. E9–3171 Filed 2–13–09; 8:45 am]
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SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA–2008–0062]
Social Security Ruling, SSR 09–3p.;
Title XVI: Determining Childhood
Disability—The Functional Equivalence
Domain of ‘‘Acquiring and Using
Information’’
Social Security Administration.
Notice of Social Security Ruling
AGENCY:
ACTION:
(SSR).
SUMMARY: We are giving notice of SSR
09–3p. This SSR consolidates
information from our regulations,
training materials, and question-andanswer documents about the functional
equivalence domain of ‘‘Acquiring and
using information.’’ It also explains our
policy about that domain.
DATES: Effective Date: March 19, 2009.
FOR FURTHER INFORMATION CONTACT:
Janet Truhe, Office of Disability
Programs, Social Security
Administration, 6401 Security
Boulevard, Baltimore, MD 21235–6401,
(410) 965–1020.
SUPPLEMENTARY INFORMATION: Although
5 U.S.C. 552(a)(1) and (a)(2) do not
require us to publish this SSR, we are
doing so under 20 CFR 402.35(b)(1).
SSRs make available to the public
precedential decisions relating to the
Federal old-age, survivors, disability,
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supplemental security income, special
veterans benefits, and black lung
benefits programs. SSRs may be based
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. 20 CFR 402.35(b)(1).
This SSR will be in effect until we
publish a notice in the Federal Register
that rescinds it, or publish a new SSR
that replaces or modifies it.
(Catalog of Federal Domestic Assistance,
Program No. 96.006 Supplemental Security
Income.)
Dated: February 9, 2009.
Michael J. Astrue,
Commissioner of Social Security.
Policy Interpretation Ruling
Title XVI: Determining Childhood
Disability—The Functional Equivalence
Domain of ‘‘Acquiring and Using
Information’’
Purpose: This SSR consolidates
information from our regulations,
training materials, and question-andanswer documents about the functional
equivalence domain of ‘‘Acquiring and
using information.’’ It also explains our
policy about that domain.
Citations: Sections 1614(a)(3),
1614(a)(4), and 1614(c) of the Social
Security Act, as amended; Regulations
No. 4, subpart P, appendix 1; and
Regulations No. 16, subpart I, sections
416.902, 416.906, 416.909, 416.923,
416.924, 416.924a, 416.924b, 416.925,
416.926, 416.926a, and 416.994a.
Introduction: A child 1 who applies
for Supplemental Security Income
(SSI) 2 is ‘‘disabled’’ if the child is not
engaged in substantial gainful activity
and has a medically determinable
physical or mental impairment or
combination of impairments 3 that
results in ‘‘marked and severe
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1 The
definition of disability in section
1614(a)(3)(C) of the Social Security Act (the Act)
applies to any ‘‘individual’’ who has not attained
age 18. In this SSR, we use the word ‘‘child’’ to refer
to any such person, regardless of whether the
person is considered a ‘‘child’’ for purposes of the
SSI program under section 1614(c) of the Act.
2 For simplicity, we refer in this SSR only to
initial claims for benefits. However, the policy
interpretations in this SSR also apply to continuing
disability reviews of children under section
1614(a)(4) of the Act and 20 CFR 416.994a.
3 We use the term ‘‘impairment(s)’’ in this SSR to
refer to an ‘‘impairment or a combination of
impairments.’’
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functional limitations.’’ 4 20 CFR
416.906. This means that the
impairment(s) must meet or medically
equal a listing in the Listing of
Impairments (the listings) 5 or
functionally equal the listings (also
referred to as ‘‘functional equivalence’’).
20 CFR 416.924 and 416.926a.
As we explain in greater detail in SSR
09–1p, we always evaluate the ‘‘whole
child’’ when we make a finding
regarding functional equivalence, unless
we can otherwise make a fully favorable
determination or decision.6 We focus
first on the child’s activities, and
evaluate how appropriately, effectively,
and independently the child functions
compared to children of the same age
who do not have impairments. 20 CFR
416.926a(b) and (c). We consider what
activities the child cannot do, has
difficulty doing, needs help doing, or is
restricted from doing because of the
impairment(s). 20 CFR 416.926a(a).
Activities are everything a child does at
home, at school, and in the community,
24 hours a day, 7 days a week.7
We next evaluate the effects of a
child’s impairment(s) by rating the
degree to which the impairment(s)
limits functioning in six ‘‘domains.’’
Domains are broad areas of functioning
intended to capture all of what a child
can or cannot do. We use the following
six domains:
(1) Acquiring and using information,
(2) Attending and completing tasks,
(3) Interacting and relating with
others,
(4) Moving about and manipulating
objects,
(5) Caring for yourself, and
4 The impairment(s) must also satisfy the duration
requirement in section 1614(a)(3)(A) of the Act; that
is, it must be expected to result in death, or must
have lasted or be expected to last for a continuous
period of not less than 12 months.
5 For each major body system, the listings
describe impairments we consider severe enough to
cause ‘‘marked and severe functional limitations.’’
20 CFR 416.925(a); 20 CFR part 404, subpart P,
appendix 1.
6 See SSR 09–1p, Title XVI: Determining
Childhood Disability Under the Functional
Equivalence Rule—The ‘‘Whole Child’’ Approach.
7 However, some children have chronic physical
or mental impairments that are characterized by
episodes of exacerbation (worsening) and remission
(improvement); therefore, their level of functioning
may vary considerably over time. To properly
evaluate the severity of a child’s limitations in
functioning, as described in the following
paragraphs, we must consider any variations in the
child’s level of functioning to determine the impact
of the chronic illness on the child’s ability to
function longitudinally; that is, over time. For more
information about how we evaluate the severity of
a child’s limitations, see SSR 09–1p. For a
comprehensive discussion of how we document a
child’s functioning, including evidentiary sources,
see SSR 09–2p, Title XVI: Determining Childhood
Disability—Documenting a Child’s ImpairmentRelated Limitations.
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(6) Health and physical well-being.
20 CFR 416.926a(b)(1).8
To functionally equal the listings, an
impairment(s) must be of listing-level
severity; that is, it must result in
‘‘marked’’ limitations in two domains of
functioning or an ‘‘extreme’’ limitation
in one domain.9 20 CFR 416.926a(a).
Policy Interpretation
General:
In the domain of ‘‘Acquiring and
using information,’’ we consider a
child’s ability to learn information and
to think about and use the information.
Children acquire and use information
at all ages for many different purposes.
For example:
• An infant shakes a rattle and learns
that it will produce noise.
• A toddler learns how to play simple
games.
• An older child learns how to read
and do arithmetic, which enables the
child to act more independently, such
as to make a purchase.
• A teenager may learn the rules and
mechanics for driving a car.
Accordingly, this domain considers
more than just assessments of cognitive
ability as measured by intelligence tests,
academic achievement instruments, or
grades in school.
Learning and thinking begin at birth.
In early infancy, children learn
primarily by exploring their world
through the senses (sight, sound, taste,
touch, and smell), but also through
movement and imitation. As they go on
to engage in play, children learn about
concepts (for example, ‘‘color,’’
‘‘shape,’’ ‘‘size,’’ and ‘‘weight’’). As they
learn that people, objects, and activities
have names, they begin to understand
that names are words, and words are
symbols that ‘‘stand for’’ what is named.
Over time, this understanding of
concepts and symbols prepares children
for using language to learn and think.
Eventually, they are expected to learn to
read, write, and do arithmetic, as well
as to acquire new information—not only
in school, but at home and in the
community.
8 For the first five domains, we describe typical
development and functioning using five age
categories: Newborns and young infants (birth to
attainment of age 1); older infants and toddlers (age
1 to attainment of age 3); preschool children (age
3 to attainment of age 6); school-age children (age
6 to attainment of age 12); and adolescents (age 12
to attainment of age 18). We do not use age
categories in the sixth domain because that domain
does not address typical development and
functioning, as we explain in SSR 09–8p, Title XVI:
Determining Childhood Disability—The Functional
Equivalence Domain of ‘‘Health and Physical WellBeing.’’
9 See 20 CFR 416.926a(e) for definitions of the
terms ‘‘marked’’ and ‘‘extreme.’’
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Throughout the learning process,
children have to think about and use the
information they have learned. Thinking
involves being able to perceive
relationships (for example, over/under
and near/far), reason, and make logical
choices. Children may do these things
by thinking in pictures, words, or both.
For example, children may solve
problems by watching and imitating
what other people do (thinking in
pictures), or by internally ‘‘talking’’
their way through them (thinking in
words). Eventually, children should be
able to use language to think about the
world, understand others, and express
themselves. As they learn more complex
language, children should be able to
combine ideas to solve problems and
perform more complex tasks.
Both mental and physical
impairments can affect a child’s ability
to acquire and use information. In
addition to mental retardation and
learning disorders, many other mental
disorders can cause limitations in the
domain of ‘‘Acquiring and using
information.’’ For example, children
with anxiety disorders may be so fearful
about failing that they cannot perform
learning-related tasks at school, such as
taking tests or making presentations.
Physical impairments, such as speech
and hearing disorders, may affect a
child’s ability to learn, especially in the
classroom. Other impairments that
frequently have effects in this domain
include, but are not limited to,
traumatic brain injury, cerebral palsy,
and meningitis.
As with limitations in any domain,
we do not consider a limitation in the
domain of ‘‘Acquiring and using
information’’ unless it results from a
medically determinable impairment(s).
However, while it is common for all
children to experience some difficulty
acquiring and using information from
time to time, a child who has significant
but unexplained problems in this
domain may have an impairment(s) that
was not alleged or has not yet been
diagnosed. In such cases, adjudicators
should pursue any indications that an
impairment(s) may be present.
Preschool and school evidence 10
Because much of a preschool or
school-age child’s learning takes place
in a school setting, preschool and school
records are often a significant source of
information about limitations in the
domain of ‘‘Acquiring and using
information.’’ Poor grades or
10 For this domain, early intervention records can
be an important source of information for children
from birth to the attainment of age 3. For more
information about how we consider early
intervention, preschool, school, and other evidence,
see SSRs 09–1p and 09–2p.
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inconsistent academic performance are
among the more obvious indicators of a
limitation in this domain provided they
result from a medically determinable
mental or physical impairment(s). Other
indications in school records that a
mental or physical impairment(s) may
be interfering with a child’s ability to
acquire and use information include,
but are not limited to:
• Special education services, such as
assignment of a personal aide who helps
the child with classroom activities in a
regular classroom, remedial or
compensatory teaching methods for
academic subjects, or placement in a
self-contained classroom.
• Related services to help the child
benefit from special education, such as
occupational, physical, or speech/
language therapy, or psychological and
counseling services.
• Other accommodations made for
the child’s impairment(s), both inside
and outside the classroom, such as
front-row seating in the classroom, more
time to take tests, having tests read to
the student, or after-school tutoring.
The kind, level, and frequency of
special education, related services, or
other accommodations a child receives
can provide helpful information about
the severity of the child’s impairment(s).
However, the lack of such indicators
does not necessarily mean that a child
has no limitations in this domain. For
various reasons, some children’s
limitations may go unnoticed until well
along in their schooling, or the children
may not receive the services that they
need.11 Therefore, when we assess a
child’s abilities in any of the domains,
we must compare the child’s
functioning to the functioning of sameage children without impairments based
on all relevant evidence in the case
record.
Although we consider formal school
evidence (such as grades and aptitude
and achievement test scores) in
determining the severity of a child’s
limitations in this domain, we do not
rely solely on such measures. We also
consider evidence about the child’s
ability to learn and think from medical
and other non-medical sources
(including the child, if the child is old
enough to provide such information),
and we assess limitations in this ability
in all settings, not just in school.
11 See 20 CFR 416.924a(b)(7)(iv), which states that
‘‘[t]he fact that you do or do not receive special
education services does not, in itself, establish your
actual limitations or abilities. Children are placed
in special education settings, or are included in
regular classrooms (with or without
accommodation), for many reasons that may or may
not be related to the level of their impairments.’’
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As already noted, we do not consider
a limitation in acquiring and using
information unless it results from a
medically determinable impairment(s).
Therefore, we do not consider
limitations that are associated with
academic underachievement by a
student who does not have a physical or
mental impairment that accounts for the
limitations.
Effects in other domains:
Children who have limitations in the
domain of ‘‘Acquiring and using
information’’ may also have limitations
in other domains. For example, mental
impairments that affect a child’s ability
to learn may also affect a child’s ability
to attend or to complete tasks. In such
cases, we evaluate limitations in both
the domains of ‘‘Acquiring and using
information’’ and ‘‘Attending and
completing tasks.’’ Also, children who
have language impairments often have
limitations in both the domains of
‘‘Acquiring and using information’’ and
‘‘Interacting and relating with others.’’
Children who have physical
impairments that affect motor
functioning, which we evaluate in the
domain of ‘‘Moving about and
manipulating objects,’’ may also have
limitations in the domain of ‘‘Acquiring
and using information.’’ Symptoms
associated with a physical
impairment(s), such as generalized or
localized pain, may interfere with a
child’s ability to concentrate (an effect
that we evaluate in the domain of
‘‘Attending and completing tasks’’), and
this will often also have effects on the
child’s ability in the domain of
‘‘Acquiring and using information.’’
Lastly, some medications for physical
impairments may affect mental
functioning, interfering with a child’s
ability to pay attention, remember, or
follow directions. We consider these
effects in the domains of ‘‘Acquiring
and using information,’’ ‘‘Attending and
completing tasks,’’ or both.
Therefore, as in any case, we evaluate
the effects of a child’s impairment(s),
including the effects of medication or
other treatment and therapies, in all
relevant domains. Rating the limitations
caused by a child’s impairment(s) in
each and every domain that is affected
is not ‘‘double-weighting’’ of either the
impairment(s) or its effects. Rather, it
recognizes the particular effects of the
child’s impairment(s) in all domains
involved in the child’s limited
activities.12
12 For more information about how we rate
limitations, including their interactive and
cumulative effects, see SSR 09–1p.
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Examples of typical functioning in the
domain of ‘‘Acquiring and using
information’’:
While there is a wide range of normal
development, most children follow a
typical course as they grow and mature.
To assist adjudicators in evaluating a
child’s impairment-related limitations
in the domain of ‘‘Acquiring and using
information,’’ we provide the following
examples of typical functioning drawn
from our regulations, training, and case
reviews. These examples are not allinclusive, and adjudicators are not
required to develop evidence about each
of them. They are simply a frame of
reference for determining whether
children are functioning typically for
their age with respect to acquiring and
using information.
1. Newborns and young infants (birth
to attainment of age 1):
• Shows interest in and explores the
environment (for example, reaches for a
toy).
• Engages in random actions that
eventually become purposeful (for
example, shakes a rattle).
• Begins to recognize and anticipate
routine situations and events (for
example, smiles at the sight of a
stroller).
• Begins to recognize and attach
meaning to everyday sounds (for
example, the telephone).
• Begins to recognize and respond to
familiar words (for example, own name,
the name of a family member, or the
word for a favorite toy or activity).
2. Older infants and toddlers (age 1 to
attainment of age 3):
• Learns how objects go together in
different ways.
• Learns through pretending that
actions can represent real things.
• Understands that words represent
people, things, places, and activities.
• Refers to self and things by pointing
and eventually naming.
• Learns concepts and solves simple
problems by purposeful
experimentation (for example, taking a
toy apart), imitation, constructive play
(for example, building with blocks), and
pretend play activities.
• Makes simple choices between two
things.
• Responds to increasingly complex
instructions and questions.
• Produces an increasing number of
words and grammatically correct simple
sentences and questions.
3. Preschool children (age 3 to
attainment of age 6):
• Develops readiness skills needed
for learning to read (for example,
listening to stories, rhyming words, or
matching letters).
• Develops readiness skills needed
for learning to do math (for example,
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counting, sorting, or building with
blocks).13
• Develops readiness skills needed
for learning to write (for example,
coloring, painting, copying shapes, or
using scissors).
• Uses words to ask questions, give
answers, describe things, provide
explanations, and tell stories.
• Follows several unrelated
directions (for example, ‘‘Put your toy in
the box and get your coat on.’’).
• Begins to understand the order of
daily routines (for example, breakfast
before lunch).
• Begins to understand and remember
own accomplishments.
• Begins to understand increasingly
complex concepts (for example, ‘‘time’’
as in yesterday, today, and tomorrow).
4. School-age Children (age 6 to
attainment of age 12):
• Learns to read, write, and do simple
arithmetic.
• Becomes interested in new subjects
and activities (for example, science
experiments and stories from history).
• Demonstrates learning by producing
oral and written projects, solving
arithmetic problems, taking tests, doing
group work, and entering into class
discussions.
• Applies learning in daily activities
at home and in the community (for
example, reading street signs, telling
time, and making change).
• Uses increasingly complex language
(vocabulary and grammar) to share
information, ask questions, express
ideas, and respond to the opinions of
others.
5. Adolescents (age 12 to attainment
of age 18):
• Continues to demonstrate learning
in academic assignments (for example,
in composition, during classroom
discussion, and by school laboratory
experiments).
• Applies learning in daily situations
without assistance (for example, going
to the store, getting a book from the
library, or using public transportation).
• Comprehends and expresses simple
and complex ideas using increasingly
complex language in academic and
daily living situations.
• Learns to apply knowledge in
practical ways that will help in
employment (for example, carrying out
instructions, completing a job
application, or being interviewed by a
potential employer).
• Plans ahead for future activities.
• Begins realistic occupational
planning.
13 When building with blocks, a child is learning
mathematical concepts such as ‘‘size’’ and
‘‘volume.’’
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Examples of limitations in the domain
of ‘‘Acquiring and using information’’:
To further assist adjudicators in
evaluating a child’s impairment-related
limitations in the domain of ‘‘Acquiring
and using information,’’ we also provide
the following examples of some of the
limitations we consider in this domain.
These examples are drawn from our
regulations and training. They are not
the only limitations in this domain, nor
do they necessarily describe a ‘‘marked’’
or an ‘‘extreme’’ limitation.
In addition, the examples below may
or may not describe limitations
depending on the expected level of
functioning for a given child’s age. For
example, a toddler would not be
expected to be able to read, but a
teenager would.14
• Does not demonstrate an
understanding of words that describe
concepts such as space, size, or time (for
example, inside/outside, big/little,
morning/night).
• Cannot rhyme words or the sounds
in words.
• Has difficulty remembering what
was learned in school the day before.
• Does not use language appropriate
for age.
• Is not developing ‘‘readiness skills’’
the same as peers (for example, learning
to count, reciting ABCs, scribbling).
• Is not reading, writing, or doing
arithmetic at appropriate grade level.
• Has difficulty comprehending
written or oral directions.
• Struggles with following simple
instructions.
• Talks only in short, simple
sentences.
• Has difficulty explaining things.
Effective date: This SSR is effective on
March 19, 2009.
Cross-References: SSR 09–1p, Title
XVI: Determining Childhood Disability
Under the Functional Equivalence
Rule—The ‘‘Whole Child’’ Approach;
SSR 09–2p, Title XVI: Determining
Childhood Disability—Documenting a
Child’s Impairment-Related Limitations;
SSR 09–4p, Title XVI: Determining
Childhood Disability—The Functional
Equivalence Domain of ‘‘Attending and
Completing Tasks’’; SSR 09–5p, Title
XVI: Determining Childhood
Disability—The Functional Equivalence
Domain of ‘‘Interacting and Relating
with Others’’; SSR 09–6p, Title XVI:
Determining Childhood Disability—The
Functional Equivalence Domain of
‘‘Moving About and Manipulating
Objects’’; SSR 09–7p, Title XVI:
Determining Childhood Disability—The
Functional Equivalence Domain of
‘‘Caring for Yourself’’; SSR 09–8p, Title
14 See
E:\FR\FM\17FEN1.SGM
20 CFR 416.924b.
17FEN1
Federal Register / Vol. 74, No. 30 / Tuesday, February 17, 2009 / Notices
XVI: Determining Childhood
Disability—The Functional Equivalence
Domain of ‘‘Health and Physical WellBeing’’; SSR 98–1p, Determining
Medical Equivalence in Title XVI
Childhood Disability Claims When a
Child Has Marked Limitations in
Cognition and Speech; and Program
Operations Manual System (POMS) DI
25225.030, DI 25225.035, DI 25225.040,
DI 25225.045, DI 25225.050, and DI
25225.055.
[FR Doc. E9–3379 Filed 2–13–09; 8:45 am]
BILLING CODE 4191–02–P
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA–2008–0062; Social
Security Ruling, SSR 09–5p]
Title XVI: Determining Childhood
Disability—The Functional Equivalence
Domain of ‘‘Interacting and Relating
With Others’’
Social Security Administration.
Notice of Social Security Ruling
AGENCY:
ACTION:
sroberts on PROD1PC70 with NOTICES
(SSR).
SUMMARY: We are giving notice of SSR
09–5p. This SSR consolidates
information from our regulations,
training materials, and question-andanswer documents about the functional
equivalence domain of ‘‘Interacting and
relating with others.’’ It also explains
our policy about that domain.
DATES: Effective Date: March 19, 2009.
FOR FURTHER INFORMATION CONTACT:
Janet Truhe, Office of Disability
Programs, Social Security
Administration, 6401 Security
Boulevard, Baltimore, MD 21235–6401,
(410) 965–1020.
SUPPLEMENTARY INFORMATION: Although
5 U.S.C. 552(a)(1) and (a)(2) do not
require us to publish this SSR, we are
doing so under 20 CFR 402.35(b)(1).
SSRs make available to the public
precedential decisions relating to the
Federal old-age, survivors, disability,
supplemental security income, special
veterans benefits, and black lung
benefits programs. SSRs may be based
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. 20 CFR 402.35(b)(1).
This SSR will be in effect until we
publish a notice in the Federal Register
VerDate Nov<24>2008
19:45 Feb 13, 2009
Jkt 217001
that rescinds it, or publish a new SSR
that replaces or modifies it.
(Catalog of Federal Domestic Assistance,
Program No. 96.006 Supplemental Security
Income.)
Dated: February 9, 2009.
Michael J. Astrue,
Commissioner of Social Security.
Policy Interpretation Ruling
Title XVI: Determining Childhood
Disability—The Functional Equivalence
Domain of ‘‘Interacting and Relating
With Others’’
Purpose: This SSR consolidates
information from our regulations,
training materials, and question-andanswer documents about the functional
equivalence domain of ‘‘Interacting and
relating with others.’’ It also explains
our policy about that domain.
Citations: Sections 1614(a)(3),
1614(a)(4), and 1614(c) of the Social
Security Act, as amended; Regulations
No. 4, subpart P, appendix 1; and
Regulations No. 16, subpart I, sections
416.902, 416.906, 416.909, 416.923,
416.924, 416.924a, 416.924b, 416.925,
416.926, 416.926a, and 416.994a.
Introduction: A child 1 who applies
for Supplemental Security Income
(SSI) 2 is ‘‘disabled’’ if the child is not
engaged in substantial gainful activity
and has a medically determinable
physical or mental impairment or
combination of impairments 3 that
results in ‘‘marked and severe
functional limitations.’’ 4 20 CFR
416.906. This means that the
impairment(s) must meet or medically
equal a listing in the Listing of
Impairments (the listings) 5 or must
functionally equal the listings, also
referred to as ‘‘functional equivalence.’’
20 CFR 416.924 and 416.926a.
As we explain in greater detail in SSR
09–1p, we always evaluate the ‘‘whole
1 The definition of disability in section
1614(a)(3)(C) of the Social Security Act (the Act)
applies to any ‘‘individual’’ who has not attained
age 18. In this SSR, we use the word ‘‘child’’ to refer
to any such person, regardless of whether the
person is considered a ‘‘child’’ for purposes of the
SSI program under section 1614(c) of the Act.
2 For simplicity, we refer in this SSR only to
initial claims for benefits. However, the policy
interpretations in this SSR also apply to continuing
disability reviews of children under section
1614(a)(4) of the Act and 20 CFR 416.994a.
3 We use the term ‘‘impairment(s)’’ in this SSR to
refer to an ‘‘impairment or a combination of
impairments.’’
4 The impairment(s) must also satisfy the duration
requirement in section 1614(a)(3)(A) of the Act; that
is, it must be expected to result in death, or must
have lasted or be expected to last for a continuous
period of not less than 12 months.
5 For each major body system, the listings
describe impairments we consider severe enough to
cause ‘‘marked and severe functional limitations.’’
20 CFR 416.925(a); 20 CFR part 404, subpart P,
appendix 1.
PO 00000
Frm 00126
Fmt 4703
Sfmt 4703
7515
child’’ when we make a finding
regarding functional equivalence, unless
we can otherwise make a fully favorable
determination or decision.6 We focus
first on the child’s activities, and
evaluate how appropriately, effectively,
and independently the child functions
compared to children of the same age
who do not have impairments. 20 CFR
416.926a(b) and (c). We consider what
activities the child cannot do, has
difficulty doing, needs help doing, or is
restricted from doing because of the
impairment(s). 20 CFR 416.926a(a).
Activities are everything a child does at
home, at school, and in the community,
24 hours a day, 7 days a week.7
We next evaluate the effects of a
child’s impairment(s) by rating the
degree to which the impairment(s)
limits functioning in six ‘‘domains.’’
Domains are broad areas of functioning
intended to capture all of what a child
can or cannot do. We use the following
six domains:
(1) Acquiring and using information,
(2) Attending and completing tasks,
(3) Interacting and relating with
others,
(4) Moving about and manipulating
objects,
(5) Caring for yourself, and
(6) Health and physical well-being.
20 CFR 416.926a(b)(1).8
To functionally equal the listings, an
impairment(s) must be of listing-level
severity; that is, it must result in
‘‘marked’’ limitations in two domains of
6 See SSR 09–1p, Title XVI: Determining
Childhood Disability Under the Functional
Equivalence Rule—The ‘‘Whole Child’’ Approach.
7 However, some children have chronic physical
or mental impairments that are characterized by
episodes of exacerbation (worsening) and remission
(improvement); therefore, their level of functioning
may vary considerably over time. To properly
evaluate the severity of a child’s limitations in
functioning, as described in the following
paragraphs, we must consider any variations in the
child’s level of functioning to determine the impact
of the chronic illness on the child’s ability to
function longitudinally; that is, over time. For more
information about how we evaluate the severity of
a child’s limitations, see SSR 09–1p. For a
comprehensive discussion of how we document a
child’s functioning, including evidentiary sources,
see SSR 09–2p, Title XVI: Determining Childhood
Disability—Documenting a Child’s ImpairmentRelated Limitations.
8 For the first five domains, we describe typical
development and functioning using five age
categories: Newborns and young infants (birth to
attainment of age 1); older infants and toddlers (age
1 to attainment of age 3); preschool children (age
3 to attainment of age 6); school-age children (age
6 to attainment of age 12); and adolescents (age 12
to attainment of age 18). We do not use age
categories in the sixth domain because that domain
does not address typical development and
functioning, as we explain in SSR 09–8p, Title XVI:
Determining Childhood Disability—The Functional
Equivalence Domain of ‘‘Health and Physical WellBeing.’’
E:\FR\FM\17FEN1.SGM
17FEN1
]]>Agencies
[Federal Register Volume 74, Number 30 (Tuesday, February 17, 2009)]
[Notices]
[Pages 7511-7515]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-3379]
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA-2008-0062]
Social Security Ruling, SSR 09-3p.; Title XVI: Determining
Childhood Disability--The Functional Equivalence Domain of ``Acquiring
and Using Information''
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Ruling (SSR).
-----------------------------------------------------------------------
SUMMARY: We are giving notice of SSR 09-3p. This SSR consolidates
information from our regulations, training materials, and question-and-
answer documents about the functional equivalence domain of ``Acquiring
and using information.'' It also explains our policy about that domain.
DATES: Effective Date: March 19, 2009.
FOR FURTHER INFORMATION CONTACT: Janet Truhe, Office of Disability
Programs, Social Security Administration, 6401 Security Boulevard,
Baltimore, MD 21235-6401, (410) 965-1020.
SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do
not require us to publish this SSR, we are doing so under 20 CFR
402.35(b)(1).
SSRs make available to the public precedential decisions relating
to the Federal old-age, survivors, disability,
[[Page 7512]]
supplemental security income, special veterans benefits, and black lung
benefits programs. SSRs may be based 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. 20 CFR 402.35(b)(1).
This SSR will be in effect until we publish a notice in the Federal
Register that rescinds it, or publish a new SSR that replaces or
modifies it.
(Catalog of Federal Domestic Assistance, Program No. 96.006
Supplemental Security Income.)
Dated: February 9, 2009.
Michael J. Astrue,
Commissioner of Social Security.
Policy Interpretation Ruling
Title XVI: Determining Childhood Disability--The Functional Equivalence
Domain of ``Acquiring and Using Information''
Purpose: This SSR consolidates information from our regulations,
training materials, and question-and-answer documents about the
functional equivalence domain of ``Acquiring and using information.''
It also explains our policy about that domain.
Citations: Sections 1614(a)(3), 1614(a)(4), and 1614(c) of the
Social Security Act, as amended; Regulations No. 4, subpart P, appendix
1; and Regulations No. 16, subpart I, sections 416.902, 416.906,
416.909, 416.923, 416.924, 416.924a, 416.924b, 416.925, 416.926,
416.926a, and 416.994a.
Introduction: A child \1\ who applies for Supplemental Security
Income (SSI) \2\ is ``disabled'' if the child is not engaged in
substantial gainful activity and has a medically determinable physical
or mental impairment or combination of impairments \3\ that results in
``marked and severe functional limitations.'' \4\ 20 CFR 416.906. This
means that the impairment(s) must meet or medically equal a listing in
the Listing of Impairments (the listings) \5\ or functionally equal the
listings (also referred to as ``functional equivalence''). 20 CFR
416.924 and 416.926a.
---------------------------------------------------------------------------
\1\ The definition of disability in section 1614(a)(3)(C) of the
Social Security Act (the Act) applies to any ``individual'' who has
not attained age 18. In this SSR, we use the word ``child'' to refer
to any such person, regardless of whether the person is considered a
``child'' for purposes of the SSI program under section 1614(c) of
the Act.
\2\ For simplicity, we refer in this SSR only to initial claims
for benefits. However, the policy interpretations in this SSR also
apply to continuing disability reviews of children under section
1614(a)(4) of the Act and 20 CFR 416.994a.
\3\ We use the term ``impairment(s)'' in this SSR to refer to an
``impairment or a combination of impairments.''
\4\ The impairment(s) must also satisfy the duration requirement
in section 1614(a)(3)(A) of the Act; that is, it must be expected to
result in death, or must have lasted or be expected to last for a
continuous period of not less than 12 months.
\5\ For each major body system, the listings describe
impairments we consider severe enough to cause ``marked and severe
functional limitations.'' 20 CFR 416.925(a); 20 CFR part 404,
subpart P, appendix 1.
---------------------------------------------------------------------------
As we explain in greater detail in SSR 09-1p, we always evaluate
the ``whole child'' when we make a finding regarding functional
equivalence, unless we can otherwise make a fully favorable
determination or decision.\6\ We focus first on the child's activities,
and evaluate how appropriately, effectively, and independently the
child functions compared to children of the same age who do not have
impairments. 20 CFR 416.926a(b) and (c). We consider what activities
the child cannot do, has difficulty doing, needs help doing, or is
restricted from doing because of the impairment(s). 20 CFR 416.926a(a).
Activities are everything a child does at home, at school, and in the
community, 24 hours a day, 7 days a week.\7\
---------------------------------------------------------------------------
\6\ See SSR 09-1p, Title XVI: Determining Childhood Disability
Under the Functional Equivalence Rule--The ``Whole Child'' Approach.
\7\ However, some children have chronic physical or mental
impairments that are characterized by episodes of exacerbation
(worsening) and remission (improvement); therefore, their level of
functioning may vary considerably over time. To properly evaluate
the severity of a child's limitations in functioning, as described
in the following paragraphs, we must consider any variations in the
child's level of functioning to determine the impact of the chronic
illness on the child's ability to function longitudinally; that is,
over time. For more information about how we evaluate the severity
of a child's limitations, see SSR 09-1p. For a comprehensive
discussion of how we document a child's functioning, including
evidentiary sources, see SSR 09-2p, Title XVI: Determining Childhood
Disability--Documenting a Child's Impairment-Related Limitations.
---------------------------------------------------------------------------
We next evaluate the effects of a child's impairment(s) by rating
the degree to which the impairment(s) limits functioning in six
``domains.'' Domains are broad areas of functioning intended to capture
all of what a child can or cannot do. We use the following six domains:
(1) Acquiring and using information,
(2) Attending and completing tasks,
(3) Interacting and relating with others,
(4) Moving about and manipulating objects,
(5) Caring for yourself, and
(6) Health and physical well-being.
20 CFR 416.926a(b)(1).\8\
---------------------------------------------------------------------------
\8\ For the first five domains, we describe typical development
and functioning using five age categories: Newborns and young
infants (birth to attainment of age 1); older infants and toddlers
(age 1 to attainment of age 3); preschool children (age 3 to
attainment of age 6); school-age children (age 6 to attainment of
age 12); and adolescents (age 12 to attainment of age 18). We do not
use age categories in the sixth domain because that domain does not
address typical development and functioning, as we explain in SSR
09-8p, Title XVI: Determining Childhood Disability--The Functional
Equivalence Domain of ``Health and Physical Well-Being.''
---------------------------------------------------------------------------
To functionally equal the listings, an impairment(s) must be of
listing-level severity; that is, it must result in ``marked''
limitations in two domains of functioning or an ``extreme'' limitation
in one domain.\9\ 20 CFR 416.926a(a).
---------------------------------------------------------------------------
\9\ See 20 CFR 416.926a(e) for definitions of the terms
``marked'' and ``extreme.''
---------------------------------------------------------------------------
Policy Interpretation
General:
In the domain of ``Acquiring and using information,'' we consider a
child's ability to learn information and to think about and use the
information.
Children acquire and use information at all ages for many different
purposes. For example:
An infant shakes a rattle and learns that it will produce
noise.
A toddler learns how to play simple games.
An older child learns how to read and do arithmetic, which
enables the child to act more independently, such as to make a
purchase.
A teenager may learn the rules and mechanics for driving a
car.
Accordingly, this domain considers more than just assessments of
cognitive ability as measured by intelligence tests, academic
achievement instruments, or grades in school.
Learning and thinking begin at birth. In early infancy, children
learn primarily by exploring their world through the senses (sight,
sound, taste, touch, and smell), but also through movement and
imitation. As they go on to engage in play, children learn about
concepts (for example, ``color,'' ``shape,'' ``size,'' and ``weight'').
As they learn that people, objects, and activities have names, they
begin to understand that names are words, and words are symbols that
``stand for'' what is named. Over time, this understanding of concepts
and symbols prepares children for using language to learn and think.
Eventually, they are expected to learn to read, write, and do
arithmetic, as well as to acquire new information--not only in school,
but at home and in the community.
[[Page 7513]]
Throughout the learning process, children have to think about and
use the information they have learned. Thinking involves being able to
perceive relationships (for example, over/under and near/far), reason,
and make logical choices. Children may do these things by thinking in
pictures, words, or both. For example, children may solve problems by
watching and imitating what other people do (thinking in pictures), or
by internally ``talking'' their way through them (thinking in words).
Eventually, children should be able to use language to think about the
world, understand others, and express themselves. As they learn more
complex language, children should be able to combine ideas to solve
problems and perform more complex tasks.
Both mental and physical impairments can affect a child's ability
to acquire and use information. In addition to mental retardation and
learning disorders, many other mental disorders can cause limitations
in the domain of ``Acquiring and using information.'' For example,
children with anxiety disorders may be so fearful about failing that
they cannot perform learning-related tasks at school, such as taking
tests or making presentations. Physical impairments, such as speech and
hearing disorders, may affect a child's ability to learn, especially in
the classroom. Other impairments that frequently have effects in this
domain include, but are not limited to, traumatic brain injury,
cerebral palsy, and meningitis.
As with limitations in any domain, we do not consider a limitation
in the domain of ``Acquiring and using information'' unless it results
from a medically determinable impairment(s). However, while it is
common for all children to experience some difficulty acquiring and
using information from time to time, a child who has significant but
unexplained problems in this domain may have an impairment(s) that was
not alleged or has not yet been diagnosed. In such cases, adjudicators
should pursue any indications that an impairment(s) may be present.
Preschool and school evidence \10\
---------------------------------------------------------------------------
\10\ For this domain, early intervention records can be an
important source of information for children from birth to the
attainment of age 3. For more information about how we consider
early intervention, preschool, school, and other evidence, see SSRs
09-1p and 09-2p.
---------------------------------------------------------------------------
Because much of a preschool or school-age child's learning takes
place in a school setting, preschool and school records are often a
significant source of information about limitations in the domain of
``Acquiring and using information.'' Poor grades or inconsistent
academic performance are among the more obvious indicators of a
limitation in this domain provided they result from a medically
determinable mental or physical impairment(s). Other indications in
school records that a mental or physical impairment(s) may be
interfering with a child's ability to acquire and use information
include, but are not limited to:
Special education services, such as assignment of a
personal aide who helps the child with classroom activities in a
regular classroom, remedial or compensatory teaching methods for
academic subjects, or placement in a self-contained classroom.
Related services to help the child benefit from special
education, such as occupational, physical, or speech/language therapy,
or psychological and counseling services.
Other accommodations made for the child's impairment(s),
both inside and outside the classroom, such as front-row seating in the
classroom, more time to take tests, having tests read to the student,
or after-school tutoring.
The kind, level, and frequency of special education, related
services, or other accommodations a child receives can provide helpful
information about the severity of the child's impairment(s). However,
the lack of such indicators does not necessarily mean that a child has
no limitations in this domain. For various reasons, some children's
limitations may go unnoticed until well along in their schooling, or
the children may not receive the services that they need.\11\
Therefore, when we assess a child's abilities in any of the domains, we
must compare the child's functioning to the functioning of same-age
children without impairments based on all relevant evidence in the case
record.
---------------------------------------------------------------------------
\11\ See 20 CFR 416.924a(b)(7)(iv), which states that ``[t]he
fact that you do or do not receive special education services does
not, in itself, establish your actual limitations or abilities.
Children are placed in special education settings, or are included
in regular classrooms (with or without accommodation), for many
reasons that may or may not be related to the level of their
impairments.''
---------------------------------------------------------------------------
Although we consider formal school evidence (such as grades and
aptitude and achievement test scores) in determining the severity of a
child's limitations in this domain, we do not rely solely on such
measures. We also consider evidence about the child's ability to learn
and think from medical and other non-medical sources (including the
child, if the child is old enough to provide such information), and we
assess limitations in this ability in all settings, not just in school.
As already noted, we do not consider a limitation in acquiring and
using information unless it results from a medically determinable
impairment(s). Therefore, we do not consider limitations that are
associated with academic underachievement by a student who does not
have a physical or mental impairment that accounts for the limitations.
Effects in other domains:
Children who have limitations in the domain of ``Acquiring and
using information'' may also have limitations in other domains. For
example, mental impairments that affect a child's ability to learn may
also affect a child's ability to attend or to complete tasks. In such
cases, we evaluate limitations in both the domains of ``Acquiring and
using information'' and ``Attending and completing tasks.'' Also,
children who have language impairments often have limitations in both
the domains of ``Acquiring and using information'' and ``Interacting
and relating with others.''
Children who have physical impairments that affect motor
functioning, which we evaluate in the domain of ``Moving about and
manipulating objects,'' may also have limitations in the domain of
``Acquiring and using information.'' Symptoms associated with a
physical impairment(s), such as generalized or localized pain, may
interfere with a child's ability to concentrate (an effect that we
evaluate in the domain of ``Attending and completing tasks''), and this
will often also have effects on the child's ability in the domain of
``Acquiring and using information.'' Lastly, some medications for
physical impairments may affect mental functioning, interfering with a
child's ability to pay attention, remember, or follow directions. We
consider these effects in the domains of ``Acquiring and using
information,'' ``Attending and completing tasks,'' or both.
Therefore, as in any case, we evaluate the effects of a child's
impairment(s), including the effects of medication or other treatment
and therapies, in all relevant domains. Rating the limitations caused
by a child's impairment(s) in each and every domain that is affected is
not ``double-weighting'' of either the impairment(s) or its effects.
Rather, it recognizes the particular effects of the child's
impairment(s) in all domains involved in the child's limited
activities.\12\
---------------------------------------------------------------------------
\12\ For more information about how we rate limitations,
including their interactive and cumulative effects, see SSR 09-1p.
---------------------------------------------------------------------------
[[Page 7514]]
Examples of typical functioning in the domain of ``Acquiring and
using information'':
While there is a wide range of normal development, most children
follow a typical course as they grow and mature. To assist adjudicators
in evaluating a child's impairment-related limitations in the domain of
``Acquiring and using information,'' we provide the following examples
of typical functioning drawn from our regulations, training, and case
reviews. These examples are not all-inclusive, and adjudicators are not
required to develop evidence about each of them. They are simply a
frame of reference for determining whether children are functioning
typically for their age with respect to acquiring and using
information.
1. Newborns and young infants (birth to attainment of age 1):
Shows interest in and explores the environment (for
example, reaches for a toy).
Engages in random actions that eventually become
purposeful (for example, shakes a rattle).
Begins to recognize and anticipate routine situations and
events (for example, smiles at the sight of a stroller).
Begins to recognize and attach meaning to everyday sounds
(for example, the telephone).
Begins to recognize and respond to familiar words (for
example, own name, the name of a family member, or the word for a
favorite toy or activity).
2. Older infants and toddlers (age 1 to attainment of age 3):
Learns how objects go together in different ways.
Learns through pretending that actions can represent real
things.
Understands that words represent people, things, places,
and activities.
Refers to self and things by pointing and eventually
naming.
Learns concepts and solves simple problems by purposeful
experimentation (for example, taking a toy apart), imitation,
constructive play (for example, building with blocks), and pretend play
activities.
Makes simple choices between two things.
Responds to increasingly complex instructions and
questions.
Produces an increasing number of words and grammatically
correct simple sentences and questions.
3. Preschool children (age 3 to attainment of age 6):
Develops readiness skills needed for learning to read (for
example, listening to stories, rhyming words, or matching letters).
Develops readiness skills needed for learning to do math
(for example, counting, sorting, or building with blocks).\13\
---------------------------------------------------------------------------
\13\ When building with blocks, a child is learning mathematical
concepts such as ``size'' and ``volume.''
---------------------------------------------------------------------------
Develops readiness skills needed for learning to write
(for example, coloring, painting, copying shapes, or using scissors).
Uses words to ask questions, give answers, describe
things, provide explanations, and tell stories.
Follows several unrelated directions (for example, ``Put
your toy in the box and get your coat on.'').
Begins to understand the order of daily routines (for
example, breakfast before lunch).
Begins to understand and remember own accomplishments.
Begins to understand increasingly complex concepts (for
example, ``time'' as in yesterday, today, and tomorrow).
4. School-age Children (age 6 to attainment of age 12):
Learns to read, write, and do simple arithmetic.
Becomes interested in new subjects and activities (for
example, science experiments and stories from history).
Demonstrates learning by producing oral and written
projects, solving arithmetic problems, taking tests, doing group work,
and entering into class discussions.
Applies learning in daily activities at home and in the
community (for example, reading street signs, telling time, and making
change).
Uses increasingly complex language (vocabulary and
grammar) to share information, ask questions, express ideas, and
respond to the opinions of others.
5. Adolescents (age 12 to attainment of age 18):
Continues to demonstrate learning in academic assignments
(for example, in composition, during classroom discussion, and by
school laboratory experiments).
Applies learning in daily situations without assistance
(for example, going to the store, getting a book from the library, or
using public transportation).
Comprehends and expresses simple and complex ideas using
increasingly complex language in academic and daily living situations.
Learns to apply knowledge in practical ways that will help
in employment (for example, carrying out instructions, completing a job
application, or being interviewed by a potential employer).
Plans ahead for future activities.
Begins realistic occupational planning.
Examples of limitations in the domain of ``Acquiring and using
information'':
To further assist adjudicators in evaluating a child's impairment-
related limitations in the domain of ``Acquiring and using
information,'' we also provide the following examples of some of the
limitations we consider in this domain. These examples are drawn from
our regulations and training. They are not the only limitations in this
domain, nor do they necessarily describe a ``marked'' or an ``extreme''
limitation.
In addition, the examples below may or may not describe limitations
depending on the expected level of functioning for a given child's age.
For example, a toddler would not be expected to be able to read, but a
teenager would.\14\
---------------------------------------------------------------------------
\14\ See 20 CFR 416.924b.
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Does not demonstrate an understanding of words that
describe concepts such as space, size, or time (for example, inside/
outside, big/little, morning/night).
Cannot rhyme words or the sounds in words.
Has difficulty remembering what was learned in school the
day before.
Does not use language appropriate for age.
Is not developing ``readiness skills'' the same as peers
(for example, learning to count, reciting ABCs, scribbling).
Is not reading, writing, or doing arithmetic at
appropriate grade level.
Has difficulty comprehending written or oral directions.
Struggles with following simple instructions.
Talks only in short, simple sentences.
Has difficulty explaining things.
Effective date: This SSR is effective on March 19, 2009.
Cross-References: SSR 09-1p, Title XVI: Determining Childhood
Disability Under the Functional Equivalence Rule--The ``Whole Child''
Approach; SSR 09-2p, Title XVI: Determining Childhood Disability--
Documenting a Child's Impairment-Related Limitations; SSR 09-4p, Title
XVI: Determining Childhood Disability--The Functional Equivalence
Domain of ``Attending and Completing Tasks''; SSR 09-5p, Title XVI:
Determining Childhood Disability--The Functional Equivalence Domain of
``Interacting and Relating with Others''; SSR 09-6p, Title XVI:
Determining Childhood Disability--The Functional Equivalence Domain of
``Moving About and Manipulating Objects''; SSR 09-7p, Title XVI:
Determining Childhood Disability--The Functional Equivalence Domain of
``Caring for Yourself''; SSR 09-8p, Title
[[Page 7515]]
XVI: Determining Childhood Disability--The Functional Equivalence
Domain of ``Health and Physical Well-Being''; SSR 98-1p, Determining
Medical Equivalence in Title XVI Childhood Disability Claims When a
Child Has Marked Limitations in Cognition and Speech; and Program
Operations Manual System (POMS) DI 25225.030, DI 25225.035, DI
25225.040, DI 25225.045, DI 25225.050, and DI 25225.055.
[FR Doc. E9-3379 Filed 2-13-09; 8:45 am]
BILLING CODE 4191-02-P
