Social Security Ruling, SSR 16-2p; Titles II and XVI: Evaluation of Claims Involving Similar Fault in the Providing of Evidence, 13439-13441 [2016-05660]

Download as PDF jstallworth on DSK7TPTVN1PROD with NOTICES Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices determination. While regulations allow the ALJ to extend the time for requesting a hearing when a claimant has ‘‘good cause’’ for the late request, the ALJ ruled that Ms. Boley lacked good cause because she had received the reconsideration notice and could have filed a hearing request herself. Ms. Boley filed a timely request for review of the ALJ’s dismissal order with the AC. When the AC denied her request for review of the ALJ’s dismissal order, Ms. Boley sought judicial review. HOLDING: The United States Court of Appeals for the Seventh Circuit concluded that a claimant for Social Security benefits may obtain judicial review of an ALJ’s dismissal order finding no good cause for a late hearing request after exhausting all available administrative remedies. STATEMENT AS TO HOW BOLEY DIFFERS FROM THE AGENCY’S POLICY: Unlike the holding in Boley, our policy provides that an ALJ’s order finding no good cause for a late hearing request and dismissing the request as untimely is not subject to judicial review. Section 205(g) of the Social Security Act, 42 U.S.C. 405(g), ‘‘clearly limits judicial review to a particular type of agency action, a ‘final decision of the [Commissioner of Social Security] made after a hearing.’ ’’ Califano v. Sanders, 430 U.S. 99, 108 (1977). The Supreme Court has also recognized that ‘‘the term ‘final decision’ is left undefined by the Act and its meaning is to be fleshed out by the [Commissioner’s] regulations.’’ Weinberger v. Salfi, 422 U.S. 749, 751 (1975). Under our regulations, the claimant must first obtain an ‘‘initial determination’’ and then complete an administrative review process consisting of several steps, ‘‘which usually must be requested within certain time periods,’’ 20 CFR 404.900(a), 416.1400(a), before obtaining a judicially reviewable ‘‘decision.’’ Not all agency actions constitute ‘‘initial determinations’’ subject to the administrative review process and, ultimately, judicial review. 20 CFR 404.903, 416.1403(a) (identifying numerous administrative actions that are not initial determinations). For example, although we will extend the time to seek a hearing upon a showing of good cause, 20 CFR 404.933(c), 416.1433(c), an administrative action denying a request to extend a time period is not an initial determination subject to the administrative review process or judicial review. 20 CFR 404.903(j), 416.1403(a)(8). VerDate Sep<11>2014 14:27 Mar 11, 2016 Jkt 238001 Further, our regulations provide that a ‘‘decision’’ means ‘‘the decision made by the administrative law judge or the Appeals Council.’’ 20 CFR 404.901, 416.1401. Of direct relevance here, the regulations distinguish between an ALJ’s ‘‘decision’’ and an ALJ’s dismissal of a claimant’s request for a hearing. An ALJ’s decision is subject to review by the agency’s AC and ultimately may be subject to judicial review. 20 CFR 404.955, 416.1455. An ALJ’s dismissal of a hearing request, 20 CFR 404.957, 416.1457, on the other hand, is not a ‘‘decision’’ within the meaning of section 205(g) of the Act. Rather, it is binding unless vacated by an ALJ or the AC, and the dismissal of a hearing request is not subject to judicial review. 20 CFR 404.959, 416.1459. EXPLANATION OF HOW WE WILL APPLY THE BOLEY DECISION WITHIN THE CIRCUIT: This Ruling applies only to claims in which all the following criteria are met: 1. The claimant did not timely request a hearing before an ALJ; 2. The ALJ dismissed the claimant’s request for a hearing; 3. The basis for the ALJ’s dismissal of the hearing request was that the claimant failed to show good cause for untimely filing of the hearing request; 4. The claimant timely filed a request for the AC to review the ALJ’s dismissal of the hearing request; 5. The AC denied the claimant’s request for review; and 6. The claimant resided in Indiana, Illinois, or Wisconsin at the time the AC denied review. If a case meets these criteria, we will send notice explaining that the claimant may appeal the dismissal to the Federal district court for the judicial district in Illinois, Indiana, or Wisconsin in which the claimant resides. [FR Doc. 2016–05663 Filed 3–11–16; 8:45 am] BILLING CODE 4191–02–P 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 Social Security Administration. Notice of Social Security Ruling AGENCY: ACTION: (SSR). 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 SUMMARY: PO 00000 Frm 00130 Fmt 4703 Sfmt 4703 13439 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. 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. FOR FURTHER INFORMATION CONTACT: 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. SUPPLEMENTARY INFORMATION: (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.) E:\FR\FM\14MRN1.SGM 14MRN1 13440 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices Dated: March 7, 2016. Carolyn W. Colvin, Acting Commissioner of Social Security. POLICY INTERPRETATION RULING Social Security Ruling, SSR 16–2p: jstallworth on DSK7TPTVN1PROD with NOTICES 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 VerDate Sep<11>2014 14:27 Mar 11, 2016 Jkt 238001 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. PO 00000 Frm 00131 Fmt 4703 Sfmt 4703 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 E:\FR\FM\14MRN1.SGM 14MRN1 Federal Register / Vol. 81, No. 49 / Monday, March 14, 2016 / Notices 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. jstallworth on DSK7TPTVN1PROD with NOTICES 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 VerDate Sep<11>2014 14:27 Mar 11, 2016 Jkt 238001 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 DEPARTMENT OF STATE [Public Notice: 9476] Foreign Affairs Policy Board Meeting Notice; Closed Meeting In accordance with the Federal Advisory Committee Act, 5 U.S.C. App., the Department of State announces a meeting of the Foreign Affairs Policy Board to take place on March 28, 2016, at the Department of State, Washington, DC. The Foreign Affairs Policy Board reviews and assesses: (1) Global threats and opportunities; (2) trends that implicate core national security interests; (3) tools and capacities of the civilian foreign affairs agencies; and (4) priorities and strategic frameworks for U.S. foreign policy. Pursuant to section 10(d) of the Federal Advisory Committee Act, 5 U.S.C. App 10(d), and 5 U.S.C. 552b(c)(1), it has been determined that this meeting will be closed to the public as the Board will be reviewing and discussing matters properly classified in accordance with Executive Order 13526. For more information, contact Adam Lusin at (202) 647–4967. Dated: March 7, 2016. Adam Lusin, Designated Federal Officer. [FR Doc. 2016–05676 Filed 3–11–16; 8:45 am] BILLING CODE 4710–05–P PO 00000 Frm 00132 Fmt 4703 Sfmt 4703 13441 DEPARTMENT OF STATE [Public Notice 9474] In the Matter of the Designation of Abdul Saboor, aka Engineer Saboor, aka Abdul Saboor Nasratyar as a Specially Designated Global Terrorist Acting under the authority of and in accordance with section 1(b) of Executive Order 13224 of September 23, 2001, as amended by Executive Order 13268 of July 2, 2002, and Executive Order 13284 of January 23, 2003, I hereby determine that the individual known as Abdul Saboor, also known as Engineer Saboor, also known as Abdul Saboor Nasratyar committed, or poses a significant risk of committing, acts of terrorism that threaten the security of U.S. nationals or the national security, foreign policy, or economy of the United States. Consistent with the determination in section 10 of Executive Order 13224 that ‘‘prior notice to persons determined to be subject to the Order who might have a constitutional presence in the United States would render ineffectual the blocking and other measures authorized in the Order because of the ability to transfer funds instantaneously,’’ I determine that no prior notice needs to be provided to any person subject to this determination who might have a constitutional presence in the United States, because to do so would render ineffectual the measures authorized in the Order. This notice shall be published in the Federal Register. Dated: March 4, 2016. John F. Kerry, Secretary of State. [FR Doc. 2016–05673 Filed 3–11–16; 8:45 am] BILLING CODE 4710–AD–P DEPARTMENT OF STATE [Public Notice: 9459] Notice of Meeting of the Cultural Property Advisory Committee There will be a meeting of the Cultural Property Advisory Committee (‘‘the Committee’’) May 24–26, 2016, at the United States Department of State, Harry S Truman Building, 2201 C Street NW., and State Annex 5, 2200 C Street NW., Washington, DC. The Committee’s responsibilities are carried out in accordance with provisions of the Convention on Cultural Property Implementation Act (19 U.S.C. 2601 et seq.) (‘‘the Act’’). A portion of this meeting will be closed to the public E:\FR\FM\14MRN1.SGM 14MRN1

Agencies

[Federal Register Volume 81, Number 49 (Monday, March 14, 2016)]
[Notices]
[Pages 13439-13441]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[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