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]
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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).
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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
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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 https://
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.)
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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
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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.
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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
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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
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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
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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
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]]>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
https://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
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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
