pital insurance benefits or supplementary medical insurance benefits under title XVIII of the act. (See § 422.203 for a discussion of the hearing procedure.) HA-501.1-Request for Hearing-Part A Health Insurance. (For use by an individual or institution to obtain a hearing before an administrative law judge of the Social Security Administration concerning the amount of hospital insurance benefits under title XVIII.) HA-5121-Notice by Attorney of Appointment as Representative. (For use by an attorney authorized by a claimant to act for him in a claim or related matter.) HA-520-Request for Review of Hearing Examiner's Action. (For use by an individual or institution to obtain a review of a decision by an administrative law judge of the Social Security Administration.)

[38 FR 11452, May 8, 1973]

§ 422.520

Forms related to maintenance of earnings records.

The following forms are used by the Social Security Administration and by the public in connection with the maintenance of earnings records of wageearners and self-employed persons: SS-4-Application for Employer Identification Number.

SS-4A-Agricultural Employer's Application.

(For use by employers of agricultural workers to request an employer identification number under the FICA.) SS-5-Application for a Social Security Number (or Replacement of Lost Card). SS-15-Certificate Waiving Exemption From Taxes Under the FICA. (For use by certain nonprofit organizations requesting coverage of its employees.)

SS-15a-List of Concurring Employees. (To be signed by each employee who concurs in the filing of the Certificate Waiving Exemption From Taxes Under the FICA, Form SS-15.)

SSI-21-Social Security and Your Household Employee. (For use by employers of household workers to request information from the Internal Revenue Service Center regarding filing employee tax returns.) OA-702-Social Security Number Card. Form 2031-Waiver Certificate To Elect Social Security Coverage for Use by Ministers, Certain Members of Religious Orders, and Christian Science Practitioners. Form 4029-Application for Exemption from Tax on Self-Employment Income and Waiver of Benefits. (To be completed by self-employed individuals who are members of certain recognized religious sects (or division thereof) and do not wish to pay FICA taxes or participate in the programs provided under titles II and XVIII.) Form 4361-Application for Exemption From Self-Employment Tax for Use by Ministers, Members of Religious Orders, and Christian Science Practitioners.

Form 4415-Election To Exempt From SelfEmployment Coverage Fees Received by Certain Public Officers and Employees of a State or Political Subdivision Thereof OAAN-5028-Evidence of Application for

Social Security Number Card. OAAN-7003-Request for Change in Social Security Records. (For use by an individual to change information given on original application for a social security number.)

OAR-7004-Request for Statement of Earnings. (For use by worker to obtain a statement of earnings recorded in his earnings record.)

OAR-7008-Request for Correction of Earnings Record. (For use by an individual who wishes to have his earnings record revised.)

SSA-7011-Statement of Employer. (For use by an employer to provide evidence of wage payments in cases of a wage discrepancy in an individual's earnings record.) [38 FR 11452, May 8, 1973]

§ 422.525 Where applications and other forms are available.

All applications and related forms prescribed for use in the programs administered by the Social Security Administration pursuant to the provisions of titles II and XVIII of the act, and part B of title IV of the Federal Coal Mine Health and Safety Act of 1969 are printed under the specifications of the Administration and distributed free of charge to the public, institutions, or organizations for the purposes described therein. All prescribed forms can be obtained upon request from any social security district office or branch office (see § 422.5). Forms appropriate for use in requesting payment for services provided under the health insurance for the aged and disabled programs can also be obtained from the intermediaries or carriers (organizations under contract with the Social Security Administration to make payment for such services) without charge. Form 2031 (Waiver Certificate to Elect Social Security Coverage for Use by Ministers, Certain Members of Religious Orders, and Christian Science Practitioners), Form 4029 (Application for Exemption From Tax on SelfEmployment Income and Waiver of Benefits), Form 4361 (Application for Exemption From Self-Employment Tax for Use by Ministers, Members of Religious Orders, and Christian Science Practitioners), Form 4415 (Election to Exempt From Self-Employment Coverage Fees Received by Certain Public Officers and Employees of a State or a Political Subdivision Thereof), Form SS-4 (Applica

tion for Employer Identification Number), Form SS-4A (Agricultural Employer's Application for Identification Number), Form SS-5 (Application for a Social Security Number (or Replacement of Lost Card)), Form SS-15 (Certificate Waiving Exemption From Taxes Under the FICA), and Form SS-15a (List of Concurring Employees) can also be obtained without charge from offices of the Internal Revenue Service. For other offices where applications and certain other forms can be obtained, see Subparts B and C of this Part 422.

[38 FR 11452, May 8, 1973]

§ 422.527 Private printing and modifica tion of prescribed applications and other forms.

Any person, institution, or organization wishing to reproduce, duplicate, or privately print any application or other form prescribed by the Administration should obtain the prior approval of the Administration. Requests for approval to so reproduce any prescribed form must be in writing and include the reason or need for such reproduction, the intended user of the form, the proposed modifications, if any, the proposed format, with printing or other specifications, the type of automatic data processing machinery (e.g., printer, burster, mail handling), if any, for which the form is being designed, estimated printing quantity, estimated cost per thousand, estimated annual usage, and such other pertinent information as may be required by the Administration. All requests are to be forwarded to: Social Security Administration, Printing and Records Management Branch, Baltimore, Md. 21235.

[33 F.R. 11281, Aug. 8, 1968]

Pub. L. 93-641, the National Health Planning and Resources Development Act of 1974, provides the Department of Health, Education, and Welfare with the authority to provide grants to State agencies for the purpose of demonstrating the effectiveness of health care rate regulation. Section 1526 provides:

GRANTS FOR RATE REGULATION

"Sec. 1526. (a) For the purpose of demonstrating the effectiveness of State Agencies regulating rates for the provision of health care, the Secretary may make to a State Agency designated, under an agreement entered under section 1521(b) (3), for a State which (in accordance with regulations prescribed by the Secretary) has indicated an intent to regulate (not later than six months after the date of the enactment of this title) rates for the provision of health care within the State. Not more than six State Agencies may receive grants under this subsection.

(b) (1) A State Agency which receives a grant under subsection (a) shall

(A) provide the Secretary satisfactory evidence that the State Agency has under State law the authority to carry out rate regulation functions in accordance with this section and provide the Secretary a current budget for the performance of such functions by it;

(B) set forth in such detail as the Secretary may prescribe the qualifications for personnel having responsibility in the performance of such functions, and shall have a professional staff for rate regulation, which staff shall be headed by a Director;

(C) provide for such methods of administration as found by the Secretary to be necessary for the proper and efficient administration of such functions;

(D) perform its functions in accordance with procedures established and published by it, which procedures shall conform to the requirements of section 1532;

(E) comply with the requirements prescribed by paragraphs (6) through (12) of section 1522 (b) with respect to the functions prescribed by subsection (a);

(F) provide for the establishment of a procedure under which the State Agency will obtain the recommendation of the appropriate health systems agency prior to conducting a review of the rates charged or proposed to be charged for services; and

(G) meet such other requirements as the Secretary may prescribe.

(B) create incentives at each point in the delivery of health services for utilization of the most economical modes of services feasible,

(C) document the need for and cost implications of each new service for which a determination of reimbursement rates is sought, and

(D) employ for each type or class of person engaged in the delivery of health services

(1) a unit for determining the reimbursement rates, and

(11) a base for determining rates of change in the reimbursement rates,

which unit and base are satisfactory to the Secretary.

(c) Grants under subsection (a) shall be made on such terms and conditions as the Secretary may prescribe, except that (1) such a grant shall be available for obligation only during the one-year period beginning on the date such grant was made, and (2) no State Agency may receive more than three grants under subsection (a).

(d) Each State Agency which receives a grant under subsection (a) shall report to the Secretary (in such form and manner as he shall prescribe) on the effectiveness of the rate regulation program assisted by such grant. The Secretary shall report annually to the Congress on the effectiveness of the programs assisted by the grants authorized by subsection (a).

(e) There are authorized to be appropriated to make payments under grants under subsection (a), $4,000,000 for the fiscal year ending June 30, 1975, $5,000,000 for the fiscal year ending June 30, 1976, and $6,000,000 for the fiscal year ending June 30, 1977.

(b) Grants will be made to those State Agencies which meet the requirements set forth in section 1526 and regulations implementing that section.

(c) Subsection (a) of section 1526 prescribes the method by which a State must establish its eligibility to file an application for grants under Section 1526. [40 FR 42865, Sept. 17, 1975]

§ 450.103 Definitions and use of terms.

(a) "Act" refers to the Public Health Service Act, as amended by section 3 of Pub. L. 93-641.

(b) "Secretary" means the Secretary of the Department of Health, Education, and Welfare or his designee.

(c) "State," unless otherwise indicated, includes each of the 50 States, the District of Columbia, and the Commonwealth of Puerto Rico.

(d) "State Agency" means a State agency designated under an agreement entered into under section 1521(b) (3) of the Public Health Service Act, as amended.

(e) "Grant" shall mean an award of funds pursuant to Subpart A of Regulations No. 50 based upon an application approved thereunder for the purpose of carrying out activities approved under that subpart.

[40 FR 42865, Sept. 17, 1975, as amended at 40 FR 44812, Sept. 30, 1975]

§ 450.105 Establishing eligibility to file application.

(a) The Secretary shall, by notice forwarded to the chief administrative official of each State, invite each State to indicate that it intends to regulate health care rates. All States (as defined in § 450.103(c)) shall be eligible to make this indication. Any State wishing to become eligible to file an application for funding under Section 1526 shall respond to that notice in a writing dispatched to the Secretary or his designee no later than July 4, 1975. If the State responds by letter, any letter postmarked on or before July 4, 1975, will be considered as meeting the requirements of this section.

(b) States which are regulating rates as of July 4, 1975, but which do not respond to the Secretary's letter, will be considered to have indicated intent to regulate rates for purposes of Section 1526(a).

(c) In order to be eligible to file an application for a grant under Section 1526, a State must be regulating rates as of July 4, 1975, or have indicated by July 4, 1975, an intent to regulate rates. [40 FR 42865, Sept. 17, 1975]

Rules of Procedure

1.13 Place of proceedings. AUTHORITY: The provisions of this Part 1 issued under sec. 32, 39 Stat. 749, 5 U.S.C. 45; sec. 3, Reorganization Plan No. 2 of 1946, Stat. 1095; 3 CFR 1943-48 Comp., p. 1064; KC. 2. Reorganization Plan No. 19 of 1950, 64 tat. 1272; 3 CFR 1949-53 Comp., p. 1010. SOURCE: The provisions of this Part 501 ppear at 27 F.R. 12186, Dec. 8, 1962, unless therwise noted.

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929

(d) "Director" means the Director of the Bureau and in the case of employees of the Canal Zone Government and of the Panama Canal Company, the Governor of the Canal Zone.

(e) "Party" means any person admitted and named as a party on the docket of the Board, including any intervenors.

(f) "Counsel" includes any person who is a member in good standing of the bar of the Supreme Court of the United States or the highest court of any State, territory, or the District of Columbia. [27 F.R. 12186, Dec. 8, 1962, as amended at 29 F.R. 13519, Oct. 1, 1964]

§ 501.2 Scope and applicability of rules; composition and jurisdiction of the Board.

(a) The regulations in this part provide the rules of practice of the Board in hearing and deciding appeals from final decisions of the Bureau.

(b) The Board consists of three members appointed by the Secretary of Labor, one of whom is designated as Chairman of the Board and administrative officer.

(c) The Board has jurisdiction to consider and decide appeals from the final decision of the Bureau in any case arising under the Act. The Board may review all relevant questions of law, fact, and discretion in such cases. There shall be no appeal with respect to any interlocutory matter disposed of by the Bureau during the pendency of a case. The review of a case shall be limited to the evidence in the case record which was before the Bureau at the time of its final decision.

§ 501.3 Application for review.

(a) Who may file. Any person adversely affected by a final decision of the Director, or his duly authorized representative, may file an application for review of such decision by the Board.

(b) Place of filing. Any application for review shall be filed with the Clerk of the Board, Employees' Compensation Appeals Board, U.S. Department of Labor, Washington 25. D.C.

(c) Form of application; contents. An application for review should be filed with the Board upon Form AB-1 (Application for Review). Any application made without the use of the form shall contain the following information: The full name and address of the applicant, the name of the injured or deceased employee, the employing establishment, the case file number assigned to the case by the Bureau, a description of the particular injury involved, the date of the injury, the place of injury, and the date of the decision being appealed. If the applicant is being represented by another person in the proceeding, the name and address of such representative should be stated. Each application shall include a succinct statement indicating the contentions of the applicant and describing with particularity any findings of fact, conclusions of law, or exercise of (or failure to exercise) discretion complained of. Any application containing incomplete information shall be returned to the applicant with a description of the additional information needed and a reasonable opportunity for furnishing any such information shall be allowed.

(d) Time for filing. (1) Except as provided in subparagraph (2) of this paragraph, any application for review by a person residing within the United States or Canada must be filed within 90 days from the date of issuance of the final decision of the Director, and any application for review by a person residing outside the United States or Canada must be filed within 180 days from the date of issuance.

(2) For good cause shown, the Board may in its discretion waive a failure to file an application within the time limitations provided in subparagraph (1) of this paragraph, but for no longer than one year from the date of issuance of the final decision of the Director.

(3) The date of filing of an application for review shall be the date upon which the application is received by the Board.

(e) Briefs and supporting statements. Any application for review may be accompanied by a brief or supporting statement.

§ 501.4 Transmittal of record.

The Board shall serve upon the Director a copy of each application for review and any brief or supporting statement accompanying it. Within 30 days from the date of such service, the Director shall transmit to the Board the record of the proceeding to which the application refers and such statement in support of his decision or other pleading as he may consider necessary, but on application of the Director, the Board may in its discretion extend such time. § 501.5 Oral argument.

(a) Notice. Whenever any party requests an opportunity to present oral argument the Board shall schedule the case for argument. Each party shall be notified at least 10 days before the date of argument. The notice shall state the issues to be heard, as determined by the Board.

(b) Time allowed. Generally not more than 1 hour shall be allowed for oral argument by any party although in appropriate cases the Board may in its discretion extend or shorten the time allowed.

(c) Failure to respond to notice. Failure to respond to a notice of oral argument shall not prejudice the rights of any party to the proceeding. The Board in its discretion may set the case for further argument upon notice or it may proceed to dispose of the appeal pursuant to § 501.6.

§ 501.6 Decisions.

(a) The decision of the Board shall contain a written opinion setting forth the reasons for the action taken and an appropriate order. The decision may consist of affirmance, reversal, remand for further development of the evidence or other appropriate action. A copy of the decision shall be sent by the Board to all parties in interest. The case record shall be returned to the Director with a copy of the decision.