(4) There has been an overpayment or underpayment of monthly benefits or a lump sum and, if so, the amount thereof, and the adjustment under section 204(a) or section 204 (d) of the Act, to be made by increasing or decreasing the monthly benefits or lump sum to which an individual is entitled; or

(5) There should be a suspension of monthly benefits to an individual entitled to disability insurance benefits by reason of blindness, for months in which It is found the individual engaged in substantial gainful activity, under section 223(a)(1) of the Act.

(c) Establishment of a period of disability. The Administration (after any determination as to the existence of disability by the appropriate State agency which may be made under a FederalState agreement pursuant to section 221 (b) of the act) shall make findings, setting forth the pertinent facts and conclusions, and an initial determination with respect to the entitlement to a period of disability of any party who has filed an application for a period of disability. The determination shall include the date such period of disability begins.

(d) Termination of monthly benefits or periods of disability. The Admin'stration (or, in a disability claim, a State agency when required by a Federal-State agreement pursuant to section 221(b) of the Act) shall, with respect to a party who has been determined to be entitled to monthly benefits, or a period of disability, make findings, setting forth the pertinent facts and conclusions, and an Initial determination as to whether, under the applicable provisions of title I of the Act, such party's entitlement to monthly benefits, or a period of disability, has ended and, if so, the last month of such entitlement or period of disability. Such findings of fact and determination shall be made whenever it appears to the Administration that such party's entitlement to monthly benefits, or a period of disability, has ended. The suspension of benefits pursuant to section 202(t) of the Act shall be considered to be a termination thereof for purposes of this section.

(e) Reinstatement of benefits. The Administration shall, with respect to an individual whose benefits have been determined to have ended under paragraph (d) of this section, make findings, setting forth the pertinent facts and conclusions, and an initial determination as to whether the individual is entitled to a

90-067 0-77——18

reinstatement of the benefits thus ended and, if so, the effective date of such reinstatement. Such findings of fact and determination shall be made whenever a party makes a written request for reinstatement or whenever evidence is received which justifies such reinstatement.

(f) Support of husband, widower, or parent. The Administration shall make findings, setting forth the pertinent facts and conclusions, and an initial determination as to whether a husband, widower, or parent meets the requirements of support from the insured individual as set forth in the pertinent provisions of section 202 of the Act. Also, whether the evidence of support was submitted to the Administration within the time limits set forth in the Act or under the provisions described in § 404.612 or § 404.617.

(g) Revision of an earnings record. When a request for the revision or further revision of an individual's earnings record is filed in accordance with § 404.805 or § 404.806, and § 404.810, the Administration shall make findings, setting forth the pertinent facts and conclusions, and an initial determination as to whether the Administration's record of such individual's wages or self-employment income should be revised, either by changing the records as to the amount or the time of payment of wages or selfemployment income or by entering or deleting items of wages or self-employment income. Any determination that an earnings record shall be revised shall specify the amount of any increase or decrease to be made, the amount of any item to be included or deleted, and the period or periods to which earnings are to be credited on the record.

(h) Applicant's failure to submit evidence. If an individual fails to submit evidence in support of his application for monthly benefits, a lump sum, for entitlement to hospital insurance benefits or supplementary medical insurance benefits, or for a period of disability, as may be requested by the Administration pursuant to any provision of the Act or Subpart H of this part, the Administration may make an initial determination disallowing the individual's claim. initial determination, however, shall specify the conditions of entitlement that the applicant has failed to establish because of his failure to submit the requested evidence.

The

(i) Underpayment due an individual now deceased. When there is an under

payment of monthly benefits or a lump sum due an individual now deceased, the Administration shall make findings and an initial determination as to whether the underpayment resulted from error, the amount of the underpayment, and the party to whom the underpayment should be paid pursuant to section 204 of the Act and §§ 404.501 and 404.503.

(j) Withdrawal of applications and requests for revision of records of earnings. When a request for withdrawal of an application, or for withdrawal of request for revision of records of earnings is denied by the Administration (see 404.615), the Administration shall make findings, setting forth the pertinent facts and conclusions, and an initial determination of denial.

(k) Cancellation of request for withdrawal. When a request for cancellation of a "request for withdrawal" of an application or of a request for revision of records of earnings is denied by the Administration (see § 404.615a), the Administration shall make findings, setting forth the pertinent facts and conclusions, and an initial determination of denial.

(1) Termination of entitlement to hospital and supplementary medical insurance benefits—(1) Hospital insurance benefits. The Administration, shall, with respect to a party who has been determined to be entitled to hospital insurance benefits, make findings, setting forth the pertinent facts and conclusions and an initial determination as to whether under the applicable provisions of title II and title XVIII of the Act, such individual's entitlement to hospital insurance benefits has ended and, if so, the last month of such entitlement.

(2) Supplementary medical insurance benefits. The Administration shall, with respect to a party who has been determined to be entitled to supplementary medical insurance benefits, make findings, setting forth the pertinent facts and conclusions, and an initial determination as to whether under section 1838 (b) (2) of the Act, such individual's entitlement to supplementary medical insurance benefits has been terminated because of nonpayment of premiums.

(m) Waiver of adjustment or recovery of monthly benefits, a lump sum, hospital insurance benefits, or supplementary medical insurance benefits. The Administration shall make findings, setting forth the pertinent facts and conclusions, and an initial dete:mination as

to whether, under sections 204(b) or 1870 (c) of the Act, there shall be no adjustment or recovery where an overpayment (including a payment under sec. 1814(e) of the Act) with respect to an individual has been made.

(n) Need for representative payment. The Social Security Administration shall make findings, setting forth the pertinent facts and conclusions and an initial determination under section 205(j) of the Act, as to (1) whether representative payment shall serve the interests of an individual by reason of his incapacity to manage his benefit payments, except that findings as to incapacity with respect to an individual under age 18 or with respect to an individual adjudged legally incompetent shall not be considered initial determinations; and (2) who shall be appointed or continued as representative payee on behalf of a beneficiary under title II of the Act (see § 404.1601)

(Secs. 202, 216, 223, 49 Stat. 623, as amended. 53 Stat. 1368, as amended, 68 Stat. 1080 as amended, 70 Stat. 815, as amended, 49 Stat. 647, as amended; 42 U.S.C. 402, 416, and 423; Secs. 205 (a), (j), and (k), and 1102 of the Social Security Act as amended, 53 Stat. 1368, as amended, 53 Stat. 1372, 49 Stat. 647, as amended, 42 U.S.C. 405(a), (j), and (k), and 1302) [25 FR 1677, Feb. 26, 1960, as amended at 27 FR 1166, Feb. 8, 1962; 28 FR 14492, Dec. 31. 1963: 31 FR. 16765. Dec. 31, 1966: 34 FR 13313, Aug. 16, 1969; 35 FR 5944, Apr. 10, 1970; 35 FR 14698, Sept. 22, 1970; 40 FR 53384, Nov. 18, 1975]

§ 404.906 Administrative actions which are not initial determinations.

Administrative actions which shall not be considered initial determinations under any provision of the regulations in this Subpart J, but which may receive administrative review, include, but are not limited to, the following:

(a) The suspension of benefits pursuant to section 203 (h) (3) of the Act pending investigation and determination of any factual issue as to the applicability of a deduction or deductions under section 203(b) of the Act.

(b) The suspension of benefits pursuant to section 225 of the act pending investigation and determination as to the cessation of the disability of an individual entitled to benefits under section 202(d) or 223 of the act.

(c) The denial of an application to be made representative payee for and on behalf of a beneficiary under title II of the Act (see § 404.1601).

(d) The certification of any two or more individuals of the same family for joint payment of the total benefits payable to such individuals (see § 404.904).

(e) The withholding by the Administration in any month, for the purpose of recouping an overpayment, of less than the full amount of the monthly benefit otherwise payable in that month (see } 404.502).

(f) The authorization approving or regulating the amount of the fee that may be charged or received by a representative for services before the Administration (see § 404.975 (e)).

(g) The disqualification or suspension of an individual from acting as a representative in a proceeding before the Social Security Administration (see $ 404.979).

(h) The determination by the Administration under the authority of the Federal Claims Collection Act of 1966 (31 U.S.C. 951-953) not to compromise a claim for overpayment under title II or title XVIII of the Act or not to suspend or terminate collection of such a claim or the determination to compromise such a claim, including the compromise amount and the time and manner of payment (see § 404.515).

(1) The decision on a request for an extension of time to file a report of earnings (see § 404.452).

(j) The determination by the Social Security Administration that an individual is not qualified for use of the expedited appeals process as provided in § 404.916a.

(Secs. 205(a), (j), and (k), and 1102 of the Social Security Act as amended, 53 Stat. 1368, as amended, 53 Stat. 1372, 49 Stat. 647, as amended, 42 U.S.C. 405(a), (j), and (k), and 1302) [25 FR 1677, Feb. 26, 1960, as amended at 25 FR 2127, Mar. 15, 1960; 25 FR 9469, Oct. 4, 1960; 27 FR 4513, May 11, 1962; 28 FR 14492, Dec. 31, 1963; 32 FR 7750 May 27, 1967; 33 FR 3060, Jan. 16, 1968; 34 FR 385, Jan. 10, 1969; 34 FR 6973, April 26, 1969; 34 FR 14889, Sept. 27, 1969; 38 FR 9431, Apr. 16, 1973; 40 FR 53384, 53385, Nov. 18, 1975]

§ 404.907 Notice of initial determination.

Written notice of an initial determination shall be mailed to the party to the determination at his last known address, except that no such notice shall be required in the case of a determination that a party's entitlement to benefits has ended because of such party's death (see § 404.905 (d)). If the initial

determination disallows, in whole or in part, the application or request of a party, or if the initial determination is to the effect that a husband, widower, or parent was not receiving the requisite support from an insured individual, or that a party's entitlement to benefits has ended, or that a reduction, deduction, or adjustment is to be made in benefits or a lump sum, or that a period of disability established for a party has terminated, the notice of the determination sent to the party shall state the basis for the determination. Such notice shall also inform the party of the right to reconsideration (see § 404.910). Where more than the correct amount of payment has been made, see § 404.502a.

[37 F.R. 10554, May 25, 1972]

§ 404.908 Effect of initial determination.

The initial determination shall be final and binding upon the party or parties to such determination unless it is reconsidered in accordance with §§ 404.910404.916, or it is revised in accordance with 404.956.

§ 404.909

Reconsideration and hearing.

Any party who is dissatisfied with an initial determination may request that the Administration reconsider such determination, as provided in § 404.910. If a request for reconsideration is filed, such action shall not constitute a waiver of the right to a hearing subsequent to such reconsideration if the party requesting such reconsideration is dissatisfied with the determination of the Administration made on such reconsideration; and a request for a hearing may thereafter be filed, as is provided in § 404.917.

(25 F.R. 1677, Feb. 26, 1960, as amended at 28 FR. 14492, Dec. 31, 1963]

§ 404.910 Reconsideration; right to re

consideration.

The Administration shall reconsider an initial determination if a written request for reconsideration is filed, as provided in § 404.911, by or for the party to the initial determination (see § 404.905). The Administration shall also reconsider an initial determination (unless the determination is with respect to the revision of the Administration's earnings records) if a written request for reconsideration is filed, as provided in § 404.911, by an individual as a wife, widow, divorced wife, surviving divorced

wife, surviving divorced mother, husband, widower, child, parent, individual alleging equitable entitlement to a lump sum, or representative of a decedent's estate, who makes a showing in writing that his or her rights with respect to monthly benefits, a lump sum, a period of disability, or entitlement to hospital or supplementary medical insurance beneits, may be prejudiced by such determination. The Administration shall also reconsider an initial determination relating to the revision of the Administration's record of the earnings (see

404.905 (g)) of a deceased individual if a written request for reconsideration is filed, as provided in § 404.911, by a persɔn as a widow, divorced wife, surviving divorced wife, surviving divorced mother, widower, child, parent, an individual alleging equitable entitlement to a lurp sum, or representative of the decedent's estate.

[31 F.R. 16766, Dec. 31, 1966] § 404.911

Time and place of filing re

quest. The request for reconsideration shall be made in writing and filed at an office of the Social Security Administration or, in the case of an individual in the Philippines, at the Veterans' Administration Regional Office in the Philippines, or, in the case of an individual having 10 or more years of service in the railroad industry (see Subpart 0) or of an individual entitled to an annuity on the basis of an award under the Railroad Retirement Act prior to October 30, 1951, who requests in writing reconsideration with respect to his application to establish a period of disability under section 216(i) of the Act, at an office of the Railroad Retirement Board, within 60 days after the date of receipt of notice of the initial determination, unless such time is extended as provided in § 404.612 § 404.953. For purposes of this section, the date of receipt of notice of the initial determination shall be presumed to be 5 days after the date of such notice, unless there is a reasonable showing to the contrary.

[41 FR 47917, Nov. 1, 1976]

or

$ 404.912 Parties to the reconsideration.

The parties to the reconsideration shall be the person who was the party to the initial determination (see § 404.905), and any other person referred to in

§ 404.910 upon whose request the initial determination is reconsidered.

$ 404.913 Notice of reconsideration.

If the request for reconsideration is filed by a person other than the party to the initial determination, the Administration shall, before such reconsideration, mail a written notice to such party at his last known address, informing him that the initial determination is being reconsidered. In addition, the Administration shall give such party a reasonable opportunity to present such evidence and contentions as to fact or law as he may desire relative to the determination.

[25 F.R. 1677, Feb. 26, 1960, as amended at 28 F.R. 14492, Dec. 31, 1963]

§ 404.914 Reconsidered determination.

The Administration shall, when a request for reconsideration has been filed. as provided in §§ 404.910 and 404.911, reconsider the initial determination in question and the findings upon which it was based; and upon the basis of the evidence considered in connection with the initial determination and whatever other evidence is submitted by the parties or is otherwise obtained, the Administration shall make a reconsidered determination affirming or revising, in whole or in part, the findings and determination question

in

[25 FR 1677, Feb. 26, 1960, as amended at 28 FR 14492, Dec. 31, 1963]

§ 404.915 Notice of reconsidered determination.

Written notice of the reconsidered determination shall be mailed to the parties at their last known addresses. The reconsidered determination shall state the specific reasons therefor and inform the parties of their right to a hearing (see § 404.917), or, if appropriate, the requirements for use of the expedited appeals process (see § 404.916a).

[40 FR 53386, Nov. 18, 1975]

§ 404.916 Effect of a reconsidered determination.

The reconsidered determination shall be final and binding upon all parties to the reconsideration unless a hearing is requested in accordance with § 404.918 and a decision rendered or unless such determination is revised in accordance with 404.956, or unless the expedited appeals process is used, in accordance with 404.916a.

[40 FR 53386, Nov. 18, 1975]

§ 404.916a Expedited appeals process; conditions for use of such process.

In cases in which a reconsideration determination has been made or a higher level of appeal has been reached, an expedited appeals process may be used in lieu of the hearing and Appeals Council review, if the following conditions are met:

(a) A reconsideration determination has been made by the Secretary; and (b) The individual is a party referred to in § 404.916c; and

(c) The individual has filed a written request for the expedited appeals process; and

(d) The individual has alleged, and the Secretary agrees, that the only factor precluding a favorable determination with respect to a matter referred to in § 404.905, is a statutory provision which the individual alleges to be unconstitutional; and

(e) Where more than one individual is a party referred to in § 404.916c, each and every party concurs in the request for the expedited appeals process. [40 FR 53386, Nov. 18, 1975]

§ 404.916b Expedited appeals process; place and time of filing request.

(a) Place of filing request. The request for the expedited appeals process must be made in writing and filed:

(1) At an office of the Social Security Administration; or

(2) In the case of an individual in the Phillipines, at the Veterans Administration Regional Office in the Philippines or with a presiding officer, or

(3) In the case of an individual having 10 or more years of service in the railroad industry (see Subpart 0 of this part), or of an individual entitled to an annuity on the basis of an award under the Railroad Retirement Act prior to October 30, 1951, who requests in writing the use of such process with respect to his application to establish a period of disability under section 216(i) of the Social Security Act, at an office of the Railroad Retirement Board.

(b) Time of filing request. The request for the expedited appeals process must be filed at one of the following times:

(1) No later than 60 days after the date. of receipt of notice of the reconsidered determination, unless the time is extended in accordance with the standards set out in § 404.612 or § 404.954. For purposes of this paragraph, the date of

receipt of notice of the reconsidered determination shall be presumed to be 5 days after the date of such notice, unless there is a reasonable showing to the contrary; or

(2) If a request for hearing has been timely filed (see § 404.918), at any time prior to the individual's receipt of notice of the presiding officer's decision; or

(3) Within 60 days after the date of receipt of notice of the presiding officer's decision or dismissal, unless the time is extended in accordance with the standards set out in § 404.612 or § 404.954. For purposes of this paragraph, the date of receipt of notice of the presiding officer's decision or dismissal shall be presumed to be 5 days after the date of such notice, unless there is a reasonable showing to the contrary; or

(4) If a request for review by the Appeals Council has been timely filed (see § 404.946), at any time prior to receipt by such individual of notice of the Appeals Council's final action.

[40 FR 53386, Nov. 18, 1975, as amended at 41 FR 47917, Nov. 1, 1976]

§ 404.916c Expedited appeals process; parties.

The parties to the expedited appeals process shall be the person or persons who were parties to the reconsideration determination in question and, if appropriate, parties to the hearing. [40 FR 53386, Nov. 18, 1975]

§ 404.916d Expedited appeals process; agreement requirements.

(a) (1) An authorized representative of the Secretary shall, if he determines that all conditions for the use of the expedited appeals process are met (see § 404.916a), prepare an agreement for signature of the party (parties) and an authorized representative of the Secretary.

(2) (i) Where a request for hearing has been filed, but prior to issuance of a decision a request for the expedited appeals process is filed, the Chief Administrative Law Judge of the Bureau of Hearings and Appeals, or his designee, shall determine if the conditions required for entering an agreement are met.

(ii) Where a hearing decision was the last action, or where a request for review is pending before the Appeals Council, and a request for the expedited appeals process is filed, the Chairman or Deputy Chairman of the Appeals Council, or the Chairman's designee, shall determine if