mation), to a surviving relative or the legal representative of the estate of the individual, or to others when necessary for a determination as to what supplementary benefits or services such deceased individual was eligible to receive under a public or private hospital or medical insurance or benefit plan, where the individual had consented to such disclosure prior to his death or the surviving relative or legal representative consents to such disclosure; or

(3) As to medical information relating to the individual and obtained in the administration of title II, to a surviving relative or legal representative of the estate of the individual, but only if disclosure of such medical information is reasonably necessary for a title II purpose; or

(4) As to medical information relating to the individual and obtained in the administration of title XVIII,

(1) To a surviving relative or legal representative of the estate of the individual when reasonably necessary for a title XVIII purpose; or

(ii) To a surviving relative or legal representative of the estate of the individual or to others for other than a title XVIII purpose, when such information is necessary for a determination as specified in paragraph (a) (3) (iii) of this section, a statement limited to the nature of the illness or injury and the services rendered, if the source of such information does not object to the disclosure, and in the case of disclosure to others than a surviving relative or legal representative, only if the individual had consented to such disclosure prior to his death or the surviving relative or legal representative consents to such disclosure.

(5) Statements of earnings and medical information authorized to be furnished under this paragraph may be furnished in summary form or in such detail as is determined by the Department to be consistent with the proper and efficient administration of the old-age, survivors, disability, and health insurance programs under titles II and XVIII. None of the foregoing information under this paragraph (except information furnished for the purpose of determining what benefits or services the deceased individual was eligible to receive under a public or private hospital or medical insurance or benefit program), shall be disclosed except upon written request stating the purpose thereof, and where

such disclosure is considered not detrimental to the individual or to his estate.

(c) To the employer or former employer of an individual, the social security account number of the individual, and a copy of a coverage or wage determination relating to the individual, or a summary thereof setting forth the conclusions reached and the reasons therefor, if services for or wages paid by such employer or former employer are the subject of the determination. Any other information originally supplied by an employer may be furnished to him, upon written request stating the purpose thereof, when efficient administration permits.

(d) To any officer or employee of the Treasury Department, or of the Department of Justice, of the United States, lawfully charged with the administration of titles II, VIII, IX, or XVIII of the Social Security Act, the Federal Insurance Contributions Act, the Self-Employment Contributions Acts, or the Federal Unemployment Tax Act, or any Federal income tax law, for the purpose of such administration only.

(e) Except in the case of medical information relating to an individual, to any officer or employee of an agency of the Federal Government or a State Government lawfully charged with the administration of a Federal or State unemployment compensation law or contribution or tax levied in connection therewith, for the purpose of such administration only.

(f) To any officer or employee of an agency of the Federal Government lawfully charged with the administration of a law providing for public assistance, or work relief, or pension, or retirement, or other benefit payments, only for the purpose of the proper administration of such law, or of the Social Security Act. Medical information relating to an individual and obtained in the administration of Title II, may be furnished for such a purpose to such an officer or employee only upon consent of such individual or his duly authorized representative, and of the source of such information or, if such source is not available, of a physician in the employ of the Department. Medical information relating to an individual and obtained in the administration of Title XVIII may be furnished if the source of such information does not object to the disclosure and the individual or his duly authorized representative consents to such disclosure.

(g) (1) To any officer or employee of an agency of a State government lawfully charged with the administration of a program receiving grants-in-aid under Title I, V, X, XIV, XVI, or XIX of the Social Security Act, information regarding benefits paid to an individual or his entitlement to benefits under Title II of the Social Security Act, or information with respect to entitlement of an individual or benefits provided him under Title XVIII of such act, and, if it has been determined, the date of birth of a recipient or applicant, and also whether a period of disability has been established for such recipient or applicant, the beginning and ending date of such period, and the date determined to be the date of onset of such disability, where such information is necessary to enable the agency to determine the eligibility of or the amount of benefits or services due such recipient or applicant Medical information relating to an individual and obtained in the administration of Title II, may be furnished for such a purpose to such an officer or employee only upon consent of such individual or his duly authorized representative and of the source of such information or, if such source is not available, of a physician in the employ of the Department. Medical information relating to an individual and obtained in the administration of Title XVIII may be furnished if the source of such information does not object to the disclosure and the individual or his duly authorized representative consents to such disclosure.

(2) To any officer or employee of an agency of a State Government lawfully charged with the administration of a program receiving aid under the Vocational Rehabilitation Act. for the proper administration of such program only, the information specified in the first sentence of subparagraph (1) of this paragraph and in addition:

(1) The name, address, social security account number, and such other information as may be obtained with respect to the alleged disability. of an applicant for benefits on account of disability or for a determination of disability; and

(1) The name, address, social security account number, and such other information as may be obtained with respect to the alleged disability, of any individual making inquiry concerning benefits on account of disability or concerning a determination of disability, if no objec

tion is made by such individual to the release of such information.

(3) To any officer or employee of an agency of a State government lawfully charged with the administration of & program receiving grants-in-aid under part A of title IV of the Social Security Act, the information specified in subparagraph (1) of this paragraph and in addition, in accordance with requirements and procedures issued from time to time by the Social and Rehabilitation Service, information concerning the whereabouts of an absent parent of a child of a family eligible for, an applicant for, or a recipient of, aid under a program receiving grants-in-aid under part A of title IV of the Social Security Act.

(4) Upon request in writing, to any officer or employee of a State or local agency participating in the administration of a State plan approved under titles I. X. XIV. XVI, or XIX of the Social Security Act, or any other State or local public assistance program. the most recent address of an individual, and/or the address of his most recent employer. inIcluded in the files of the Department maintained pursuant to section 205 of the Act, if:

(1) Such agency certifies that (a) an order has been issued by a court of competent jurisdiction against such individual for the support and maintenance of his child or children who are under the age of 16 in destitute or necessitous circumstances. (b) such child or children are applicants for or recipients of assistance available under such a plan or program. (c) such agency has attempted without success to secure such information from all other sources reasonably available to it, and (d) such information is requested (either for the agency's own use, or on the request and for the use of the court which issued the order) for the purpose of obtaining such support and maintenance; and

(ii) Such request referred to in this subparagraph (4) is accompanied by a certified copy of the order referred to in subdivisions (i) (a) and (d) of this subparagraph.

(h) To a Federal, State, municipal, or hospital official upon written request stating that he has the name or social security account number of a deceased or insane person or a person suffering from amnesia or who is unconscious or in a state equivalent thereto. but cannot establish such person's identity. such identifying data as is available relative

to such person which may be determined by the proper officer of the Department to be necessary to assist the requesting officer or agency to make the required identification. Information as to the existence of a legally reportable medical condition of an individual discovered in connection with an application for benefits on account of disability or for a determination of disability may also be furnished to a State or municipal agency required by local law to be furnished such information.

(1) To any officer, agency, establishment, or department of the Federal Government, charged with the duty of conducting an investigation or prosecution, for the purpose of such an investigation or prosecution involving:

(1) An inquiry to determine whether there has been a violation of any provision of the Social Security Act. the Federal Insurance Contributions Act, the Self-Employment Contributions Acts, the Federal Unemployment Tax Act, or any Federal income tax law, or of any regulation or procedure in effect thereunder, provided such violation is punishable as a crime under any of such laws or under any other Federal statute imposing criminal penalties; or

(2) An inquiry to determine whether any action of an officer or employee of the Department relating to the administration of the Social Security Act was attempted or effected with intent to defraud the United States; or

(3) An inquiry with respect to an alleged theft, forgery, alteration, unlawful negotiation, or destruction of a check issued for a benefit under Title II or Title XVIII of the Social Security Act; or

(4) An inquiry relating to the commission or threatened commission of an act of espionage or sabotage or other similar act inimical to the national security: Provided, That such information shall be disclosed only to the Federal Bureau of Investigation or the U.S. Secret Service and only upon written certification by a central official of the requesting agency that the information requested is required in an investigation of major importance to enable it to discharge its statutory responsibility for protecting the national security.

(j) Any return, file, record, report, or other paper or any information may be disclosed when it is to be used in connection with any claim or other proceeding under the Social Security Act and such disclosure is necessary for the

proper performance of the duties of any officer or employee of the Department, or of any officer or employee of a State agency to carry out an agreement entered into under section 221 of the Social Security Act, or of any officer or employee of a public or private agency or organization to carry out the health insurance provisions of Title XVIII of said act.

(k) Statistical data or other similar information not relating to any particular person which may be compiled from records regularly maintained by the Department may be disclosed when efficient administration permits. Information contained in or compiled from reports submitted by employers only (other than information relating to any identified or identifiable person except such employers, and other than information relating to any identified or identifiable self-employed individual) may be disclosed, when efficient administration permits, to any other agency of the Federal Government for use in its statistical and planning work only.

(1) The Commissioner may from time to time prescribe instructions as to the manner of disclosure of the foregoing information.

(m) Disclosure of any return, file, record, report, or other paper or information obtained in the Administration of Title II or Title XVIII of the act not relating or necessary to, or used in or in connection with, the administration of the old-age, survivors, disability, or health insurance programs conducted pursuant to such titles of the act, shall not be subject to the limitation on disclosure in section 1106 of the act and shall be made only as may be otherwise required by law and in accordance with policies prescribed by the Commissioner.

(n) To any officer or employee of an agency of a State government lawfully charged with the supervision of, or financial responsibility for, the care of a person who is mentally incompetent and who is confined in a State mental institution, information regarding his entitlement to benefits under Titles II and XVIII of the Social Security Act, and if entitled, the amount of such benefits and the name and address of the person to whom such benefits have been or are being paid. Disclosure under this paragraph shall be made only upon written certification by the State agency or institution that such information is to be used in connection with the performance of its duties under State law and that

there is no other source from which it can obtain such information.

(0) [Reserved]

(p) Pursuant to the provisions of section 290 (c) of the Immigration and Nationality Act, to any officer or employee of the Department of Justice of the United States lawfully charged with the administration of title II of such act available information required to be furnished by such section, for the purpose of such administration only, upon written request of the Attorney General of the United States or of an official of the Department of Justice duly authorized by him to make such request.

(q) Information obtained by carriers and intermediaries in the administration of title XVIII of the Act indicating unethical practices or a course of unprofessional conduct by a physician or other practitioner in furnishing services to beneficiaries may, after securing proper professional advice, be disclosed to an official of a medical or other applicable professional society or to an official of a State licensing board: Provided, That disclosure under this paragraph shall be made only upon obtaining authorization of the beneficiary where he is the source of the information, unless medical or other considerations would make it inappropriate to obtain such consent.

(r) Information obtained in the administration of title XVIII of the Act with regard to services furnished a beneficiary by providers of services, physicians, and other persons furnishing services may, where the beneficiary has no legal representative, upon written request, be disclosed to the spouse, an immediate relative or member of the household of the beneficiary, or, for good cause shown, to any other person who has evidenced a demonstrable concern in protecting the interests of the beneficiary: Provided, That disclosure under this paragraph shall be made only upon authorization by the beneficiary, unless medical or other considerations would make it inappropriate to obtain such consent. The term "legal representative" as used in this paragraph has the same meaning as in 401.4(d). §

(s) Upon request in writing by a court having jurisdiction to issue orders or entertain petitions against individuals for the support and maintenance of their children, to such court, the most recent address of an individual or the address of the individual's most recent employer. or both, for the court's exclusive use (and for no other purpose) —

(1) In issuing or determining whether to issue such an order against such individual, or

(2) In determining (in the event such Individual is not within the jurisdiction of the court) the court to which a petition for support and maintenance against such individual should be forwarded under any reciprocal arrangements with other States to obtain or modify court orders for support,

upon certification by the court that the information is requested for the use specified in this paragraph. Such certification must bear the signature of the judge or clerk of the court.

(t) [Reserved]

(u) To any officer or employee of an agency of the Federal or a State govern. ment lawfully charged with the administration of a program receiving grantsin-aid under titles V and XIX of the Social Security Act for the purpose of administration of such titles, or to any officer or employee of the Department of the Army, Department of Defense, solely for the administration of its Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the following information, except that the release of such information shall not be authorized by a fiscal intermediary or carrier:

(1) Information, including the identification number, concerning charges made by physcians and other individuals, and amounts paid under title XVIII of the Act for services furnished to beneficiaries by such physicians and other individuals to enable the agency to determine the proper amount of benefits payable for medical services performed in accordance with such programs; or

(2) Information as to physicians or other individuals that has been disclosed under paragraph (i) (1) or (q) of this section.

(v) To the public: The name of any provider of services, physician, or other person furnishing services to beneficiaries under title XVIII of the Act who

(1) Has been found by a Federal court to have been guilty of submitting false claims in connection with title XVIII; or

(2) Has been found by a carrier or intermediary, after consultation with a professional medical association functioning external to program administration or, if appropriate, the State medical authority, to have been engaged in a pattern of furnishing services to such beneficiaries which are substantially in

excess of their medical needs; except that the name of any such provider of services, physician, or other person shall not be disclosed pursuant to a finding under this subparagraph (2), unless such provider, physician, or other person, as the case may be, has first been afforded a reasonable opportunity to offer evidence on his behalf.

(3) Upon request in writing, official contractor performance review reports and other formal evaluations (including followup reviews), excluding references to internal tolerance rules and practices contained therein, internal working papers or other informal memoranda, prepared by the Social Security Administration and completed after January 31, 1973, which relate to the evaluation of the performance of (i) intermediaries and carriers under their agreements entered into pursuant to section 1816 and 1842 of the Social Security Act and (ii) State agencies under their agreements entered into pursuant to section 1864 of such Act (including comparative evaluations of the performance of such intermediaries, carriers, and State agencies). The latest Contract Performance Review Report pertaining to a particular intermediary or carrier, prepared prior to February 1, 1973, may also be disclosed to any person upon request in writing. Such reports and evaluations shall be disclosed within 30 days following the final preparation thereof by the Administration (or 30 days following the request therefor, in the case of the contract performance review report prepared prior to February 1, 1973), during which time such intermediaries, carriers, and State agencies, as the case may be, shall be afforded a reasonable opportunity to offer comments, and there shall be disclosed with such reports and evaluations any pertinent written statements furnished the Social Security Administration by such intermediaries, carriers, or State agencies on such reports and evaluations.

(4) The name of any provider of services, physician, or other person furnishing services to beneficiaries under title XVIII of the Act who

(1) Has been found by a Federal court to have been guilty of submitting false claims in connection with title XVIII; or (li) Has been found by a carrier or intermediary, after consultation with a professional medical association functioning external to program administration or, if appropriate, the State medical

9

authority, to have been engaged in a p tern of furnishing services to such ber ficiaries which are substantially in cess of their medical needs; except th the name of any such provider of ser ices, physician, or other person shall r be disclosed pursuant to a finding und this subdivision (ii), unless such pr vider, physician, or other person, as t case may be, has first been afforded reasonable opportunity to offer eviden on his behalf.

(Sec. 102(a), sec. 5, 79 Stat. 331, 67 Stat. 1 631; 42 U.S.C. 1395 hh) [20 F.R. 5159, Ju 20, 1955, as amended at 20 FR. 9504, Dec. 2 1955; 21 F.R. 9765, Dec. 11, 1956; 32 FE 14894, Oct. 27, 1967; 82 F.R. 15544, Nov. 1967; 33 F.R. 20037, Dec. 31, 1968; 34 FF 197, Jan. 7, 1969; 38 FR 7222, Mar. 19, 1973 38 FR 14826, June 6, 1973; 40 FR 27649 July 1, 1975]

As used in this part the term:

(a) "Claimant" includes a person wh files an application or is deemed to hav filed an application, on his own behal or as guardian of an infant, or as lega representative of an incompetent, or o whose behalf some other person files a application for monthly benefits, a lump sum death payment, or health insuranc benefits for the aged.

(b) "Prospective claimant" includes living wage earner or self-employed in dividual, the legal representative of a incompetent wage earner or self-em ployed individual, the guardian of an in fant, the next of kin of a deceased wag earner or self-employed individual, an other person who is equitably entitled b reason of having paid, in whole or par the burial expenses of the deceased wag earner or self-employed individual, or th legal representative of such next of ki or equitably entitled person;

(c) "Authorized representative" in cludes any individual authorized by th claimant or prospective claimant to re quest or receive information or to act o behalf of the claimant or prospectiv claimant;

(d) "Legal representative" include any individual appointed by a court o otherwise authorized by law to act o behalf of a claimant or a prospectiv claimant:

(e) "Cost of disclosing information means the actual cost of preparing fo disclosure and disclosing such informa tion to a person or agency requesting disclosure thereof authorized by §§ 401. and 401.3;