PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950–  )

Table of Contents

Subpart A—Introduction, General Provisions and Definitions

404.1Introduction.
404.2General definitions and use of terms.
404.3General provisions.

Subpart B—Insured Status and Quarters of Coverage

General

404.101Introduction.
404.102Definitions.

Fully Insured Status

404.110How we determine fully insured status.
404.111When we consider a person fully insured based on World War II active military or naval service.
404.112When we consider certain employees of private nonprofit organizations to be fully insured.
404.115Table for determining the quarters of coverage you need to be fully insured.

Currently Insured Status

404.120How we determine currently insured status.

Disability Insured Status

404.130How we determine disability insured status.
404.131When you must have disability insured status.
404.132How we determine fully insured status for a period of disability or disability insurance benefits.
404.133When we give you quarters of coverage based on military service to establish a period of disability.

Quarters of Coverage

404.140What is a quarter of coverage.
404.141How we credit quarters of coverage for calendar years before 1978.
404.142How we credit self-employment income to calendar quarters for taxable years beginning before 1978.
404.143How we credit quarters of coverage for calendar years after 1977.
404.144How we credit self-employment income to calendar years for taxable years beginning after 1977.
404.145When you acquire a quarter of coverage.
404.146When a calendar quarter cannot be a quarter of coverage.
Appendix to Subpart B of Part 404—Quarter of Coverage Amounts for Calendar Years After 1978

Subpart C—Computing Primary Insurance Amounts

General

404.201What is included in this subpart?
404.202Other regulations related to this subpart.
404.203Definitions.
404.204Methods of computing primary insurance amounts—general.

Average-Indexed-Monthly Earnings Method of Computing Primary Insurance Amounts

404.210Average-indexed-monthly-earnings method.
404.211Computing your average indexed monthly earnings.
404.212Computing your primary insurance amount from your average indexed monthly earnings.
404.213Computation where you are eligible for a pension based on your noncovered employment.

Average-Monthly-Wage Method of Computing Primary Insurance Amounts

404.220Average-monthly-wage method.
404.221Computing your average monthly wage.
404.222Use of benefit table in finding your primary insurance amount from your average monthly wage.

Guaranteed Alternative for People Reaching Age 62 After 1978 but Before 1984

404.230Guaranteed alternative.
404.231Steps in computing your primary insurance amount under the guaranteed alternative—general.
404.232Computing your average monthly wage under the guaranteed alternative.
404.233Adjustment of your guaranteed alternative when you become entitled after age 62.

Old-Start Method of Computing Primary Insurance Amounts

404.240Old-start method—general.
404.2411977 simplified old-start method.
404.242Use of old-start primary insurance amount as guaranteed alternative.
404.243Computation where you are eligible for a pension based on noncovered employment.

Special Computation Rules for People Who Had a Period of Disability

404.250Special computation rules for people who had a period of disability.
404.251Subsequent entitlement to benefits less than 12 months after entitlement to disability benefits ended.
404.252Subsequent entitlement to benefits 12 months or more after entitlement to disability benefits ended.

Special Minimum Primary Insurance Amounts

404.260Special minimum primary insurance amounts.
404.261Computing your special minimum primary insurance amount.

Cost-of-Living Increases

404.270 Cost-of-living increases.
404.271When automatic cost-of-living increases apply.
404.272Indexes we use to measure the rise in the cost-of-living.
404.273When are automatic cost-of-living increases effective?
404.274What are the measuring periods we use to calculate cost-of-living increases?
404.275How is an automatic cost-of-living increase calculated?
404.276Publication of notice of increase.
404.277When does the frozen minimum primary insurance amount increase because of cost-of-living adjustments?
404.278Additional cost-of-living increase.

Recomputing Your Primary Insurance Amount

404.280Recomputations.
404.281Why your primary insurance amount may be recomputed.
404.282Effective date of recomputations.
404.283Recomputation under method other than that used to find your primary insurance amount.
404.284Recomputations for people who reach age 62, or become disabled, or die before age 62 after 1978.
404.285Recomputations performed automatically.
404.286How to request an immediate recomputation.
404.287Waiver of recomputation.
404.288Recomputing when you are entitled to a monthly pension based on noncovered employment.

Recalculations of Primary Insurance Amounts

404.290Recalculations.
Appendixes to Subpart C of Part 404—Note
Appendix I to Subpart C of Part 404—Average of the Total Wages for Years After 1950
Appendix II to Subpart C of Part 404—Benefit Formulas Used With Average Indexed Monthly Earnings
Appendix III to Subpart C of Part 404—Benefit Table
Appendix IV to Subpart C of Part 404—Earnings Needed for a Year of Coverage After 1950
Appendix V to Subpart C of Part 404—Computing the Special Minimum Primary Insurance Amount and Related Maximum Family Benefits
Appendix VI to Subpart C of Part 404—Percentage of Automatic Increases in Primary Insurance Amounts Since 1978
Appendix VII to Subpart C of Part 404—“Old-Law” Contribution and Benefit Base

Subpart D—Old-Age, Disability, Dependents' and Survivors' Insurance Benefits; Period of Disability

General

404.301Introduction.
404.302Other regulations related to this subpart.
404.303Definitions.
404.304What are the general rules on benefit amounts?
404.305When you may not be entitled to benefits.

Old-Age and Disability Benefits

404.310When am I entitled to old-age benefits?
404.311When does my entitlement to old-age benefits begin and end?
404.312How is my old-age benefit amount calculated?
404.313What are delayed retirement credits and how do they increase my old-age benefit amount?
404.315Who is entitled to disability benefits?
404.316When entitlement to disability benefits begins and ends.
404.317How is the amount of my disability benefit calculated?
404.320Who is entitled to a period of disability.
404.321When a period of disability begins and ends.
404.322When you may apply for a period of disability after a delay due to a physical or mental condition.
404.325The termination month.

Rules Relating to Continuation of Benefits After Your Impairment Is No Longer Disabling

404.327When you are participating in an appropriate program of vocational rehabilitation services, employment services, or other support services.
404.328When your completion of the program, or your continuation in the program for a specified period of time, will increase the likelihood that you will not have to return to the disability benefit rolls.

Benefits for Spouses and Divorced Spouses

404.330Who is entitled to wife's or husband's benefits.
404.331Who is entitled to wife's or husband's benefits as a divorced spouse.
404.332 When wife's and husband's benefits begin and end.
404.333Wife's and husband's benefit amounts.
404.335How do I become entitled to widow's or widower's benefits?
404.336How do I become entitled to widow's or widower's benefits as a surviving divorced spouse?
404.337When does my entitlement to widow's and widower's benefits start and end?
404.338Widow's and widower's benefits amounts.
404.339How do I become entitled to mother's or father's benefits as a surviving spouse?
404.340How do I become entitled to mother's or father's benefits as a surviving divorced spouse?
404.341When mother's and father's benefits begin and end.
404.342Mother's and father's benefit amounts.
404.344Your relationship by marriage to the insured.
404.345Your relationship as wife, husband, widow, or widower under State law.
404.346Your relationship as wife, husband, widow, or widower based upon a deemed valid marriage.
404.347“Living in the same household” defined.
404.348When is a child living with me in my care?
404.349When is a child living apart from me in my care?

Child's Benefits

404.350Who is entitled to child's benefits?
404.351Who may be reentitled to child's benefits?
404.352When does my entitlement to child's benefits begin and end?
404.353Child's benefit amounts.
404.354Your relationship to the insured.
404.355Who is the insured's natural child?
404.356Who is the insured's legally adopted child?
404.357Who is the insured's stepchild?
404.358Who is the insured's grandchild or stepgrandchild?
404.359Who is the insured's equitably adopted child?
404.360When a child is dependent upon the insured person.
404.361When a natural child is dependent.
404.362When a legally adopted child is dependent.
404.363When is a stepchild dependent?
404.364When is a grandchild or stepgrandchild dependent?
404.365When an equitably adopted child is dependent.
404.366“Contributions for support,” “one-half support,” and “living with” the insured defined—determining first month of entitlement.
404.367When you are a “full-time elementary or secondary school student”.
404.368When you are considered a full-time student during a period of nonattendance.

Parent's Benefits

404.370Who is entitled to parent's benefits?
404.371When parent's benefits begin and end.
404.373Parent's benefit amounts.
404.374Parent's relationship to the insured.
404.380–404.384[Reserved]

Lump-Sum Death Payment

404.390General.
404.391Who is entitled to the lump-sum death payment as a widow or widower who was living in the same household?
404.392Who is entitled to the lump-sum death payment when there is no widow(er) who was living in the same household?

Subpart E—Deductions; Reductions; and Nonpayments of Benefits

404.401Deduction, reduction, and nonpayment of monthly benefits or lump-sum death payments.
404.401aWhen we do not pay benefits because of a disability beneficiary's work activity.
404.402Interrelationship of deductions, reductions, adjustments, and nonpayment of benefits.
404.403Reduction where total monthly benefits exceed maximum family benefits payable.
404.404How reduction for maximum affects insured individual and other persons entitled on his earnings record.
404.405Situations where total benefits can exceed maximum because of “savings clause.”
404.406Reduction for maximum because of retroactive effect of application for monthly benefits.
404.407Reduction because of entitlement to other benefits.
404.408Reduction of benefits based on disability on account of receipt of certain other disability benefits provided under Federal, State, or local laws or plans.
404.408aReduction where spouse is receiving a Government pension.
404.408bReduction of retroactive monthly social security benefits where supplemental security income (SSI) payments were received for the same period.
404.409What is full retirement age?
404.410How does SSA reduce my benefits when my entitlement begins before full retirement age?
404.411 How are benefits reduced for age when a person is entitled to two or more benefits?
404.412After my benefits are reduced for age when and how will adjustments to that reduction be made?
404.413After my benefits are reduced for age what happens if there is an increase in my primary insurance amount?
404.415Deductions because of excess earnings.
404.417Deductions because of noncovered remunerative activity outside the United States; 45 hour and 7-day work test.
404.418“Noncovered remunerative activity outside the United States,” defined.
404.420Persons deemed entitled to benefits based on an individual's earnings record.
404.421How are deductions made when a beneficiary fails to have a child in his or her care?
404.423Manner of making deductions.
404.424Total amount of deductions where more than one deduction event occurs in a month.
404.425Total amount of deductions where deduction events occur in more than 1 month.
404.428Earnings in a taxable year.
404.429Earnings; defined.
404.430Monthly and annual exempt amounts defined; excess earnings defined.
404.434Excess earnings; method of charging.
404.435Excess earnings; months to which excess earnings can or cannot be charged; grace year defined.
404.436Excess earnings; months to which excess earnings cannot be charged because individual is deemed not entitled to benefits.
404.437Excess earnings; benefit rate subject to deductions because of excess earnings.
404.439Partial monthly benefits; excess earnings of the individual charged against his benefits and the benefits of persons entitled (or deemed entitled) to benefits on his earnings record.
404.440Partial monthly benefits; prorated share of partial payment exceeds the benefit before deduction for excess earnings.
404.441Partial monthly benefits; insured individual and another person entitled (or deemed entitled) on the same earnings record both have excess earnings.
404.446Definition of “substantial services” and “services”.
404.447Evaluation of factors involved in substantial services test.
404.450Required reports of work outside the United States or failure to have care of a child.
404.451Penalty deductions for failure to report within prescribed time limit noncovered remunerative activity outside the United States or not having care of a child.
404.452Reports to Social Security Administration of earnings; wages; net earnings from self-employment.
404.453Penalty deductions for failure to report earnings timely.
404.454Good cause for failure to make required reports.
404.455Request by Social Security Administration for reports of earnings and estimated earnings; effect of failure to comply with request.
404.456Current suspension of benefits because an individual works or engages in self-employment.
404.457Deductions where taxes neither deducted from wages of certain maritime employees nor paid.
404.458Limiting deductions where total family benefits payable would not be affected or would be only partly affected.
404.459Penalty for making false or misleading statements or withholding information.
404.460Nonpayment of monthly benefits to aliens outside the United States.
404.461Nonpayment of lump sum after death of alien outside United States for more than 6 months.
404.462Nonpayment of hospital and medical insurance benefits of alien outside United States for more than 6 months.
404.463Nonpayment of benefits of aliens outside the United States; “foreign social insurance system,” and “treaty obligation” exceptions defined.
404.464How does deportation or removal from the United States affect the receipt of benefits?
404.465Conviction for subversive activities; effect on monthly benefits and entitlement to hospital insurance benefits.
404.466Conviction for subversive activities; effect on enrollment for supplementary medical insurance benefits.
404.467Nonpayment of benefits; individual entitled to disability insurance benefits or childhood disability benefits based on statutory blindness is engaging in substantial gainful activity.
404.468Nonpayment of benefits to prisoners.
404.469Nonpayment of benefits where individual has not furnished or applied for a Social Security number.
404.470Nonpayment of disability benefits due to noncompliance with rules regarding treatment for drug addiction or alcoholism.
404.471 Nonpayment of disability benefits for trial work period service months upon a conviction of fraudulently concealing work activity.
404.480Paying benefits in installments: Drug addiction or alcoholism.

Subpart F—Overpayments, Underpayments, Waiver of Adjustment or Recovery of Overpayments, and Liability of a Certifying Officer

404.501General applicability of section 204 of the Act.
404.502Overpayments.
404.502aNotice of right to waiver consideration.
404.503Underpayments.
404.504Relation to provisions for reductions and increases.
404.505Relationship to provisions requiring deductions.
404.506When waiver may be applied and how to process the request.
404.507Fault.
404.508Defeat the purpose of Title II.
404.509Against equity and good conscience; defined.
404.510When an individual is “without fault” in a deduction overpayment.
404.510aWhen an individual is “without fault” in an entitlement overpayment.
404.511When an individual is at “fault” in a deduction overpayment.
404.512When adjustment or recovery of an overpayment will be waived.
404.513Liability of a certifying officer.
404.515Collection and compromise of claims for overpayment.
404.520Referral of overpayments to the Department of the Treasury for tax refund offset—General.
404.521Notice to overpaid persons.
404.522Review within SSA that an overpayment is past due and legally enforceable.
404.523Findings by SSA.
404.524Review of our records related to the overpayment.
404.525Suspension of offset.
404.526Tax refund insufficient to cover amount of overpayment.
404.527Additional methods for recovery of title II benefit overpayments.
404.530Are title VIII and title XVI benefits subject to adjustment to recover title II overpayments?
404.535How much will we withhold from your title VIII and title XVI benefits to recover a title II overpayment?
404.540Will you receive notice of our intention to apply cross-program recovery?
404.545When will we begin cross-program recovery from current monthly benefits?

Subpart G—Filing of Applications and Other Forms

General Provisions

404.601Introduction.
404.602Definitions.
404.603You must file an application to receive benefits.

Applications

404.610What makes an application a claim for benefits?
404.611How do I file an application for Social Security benefits?
404.612Who may sign an application.
404.613Evidence of authority to sign an application for another.
404.614When an application or other form is considered filed.
404.615Claimant must be alive when an application is filed.
404.617Pilot program for photographic identification of disability benefit applicants in designated geographic areas.

Effective Filing Period of Application

404.620Filing before the first month you meet the requirements for benefits.
404.621What happens if I file after the first month I meet the requirements for benefits?
404.622Limiting an application.
404.623Am I required to file for all benefits if I am eligible for old-age and husband's or wife's benefits?

Filing Date Based on Written Statement

404.630Use of date of written statement as filing date.
404.631Statements filed with the Railroad Retirement Board.
404.632Statements filed with a hospital.

Deemed Filing Date Based on Misinformation

404.633Deemed filing date in a case of misinformation.

Withdrawal of Application

404.640Withdrawal of an application.
404.641Cancellation of a request to withdraw.

Subpart H—Evidence

General

404.701Introduction.
404.702Definitions.
404.703When evidence is needed.
404.704Your responsibility for giving evidence.
404.705Failure to give requested evidence.
404.706Where to give evidence.
404.707Original records or copies as evidence.
404.708How we decide what is enough evidence.
404.709Preferred evidence and other evidence.

Evidence of Age, Marriage, and Death

404.715When evidence of age is needed.
404.716Type of evidence of age to be given.
404.720Evidence of a person's death.
404.721Evidence to presume a person is dead.
404.722Rebuttal of a presumption of death.
404.723When evidence of marriage is required.
404.725Evidence of a valid ceremonial marriage.
404.726Evidence of common-law marriage.
404.727Evidence of a deemed valid marriage.
404.728Evidence a marriage has ended.

Evidence for Child's and Parent's Benefits

404.730When evidence of a parent or child relationship is needed.
404.731Evidence you are a natural parent or child.
404.732Evidence you are a stepparent or stepchild.
404.733Evidence you are the legally adopting parent or legally adopted child.
404.734Evidence you are an equitably adopted child.
404.735Evidence you are the grandchild or stepgrandchild.
404.736Evidence of a child's dependency.
404.745Evidence of school attendance for child age 18 or older.
404.750Evidence of a parent's support.

Other Evidence Requirements

404.760Evidence of living in the same household with insured person.
404.762What is acceptable evidence of having a child in my care?
404.770Evidence of where the insured person had a permanent home.
404.780Evidence of “good cause” for exceeding time limits on accepting proof of support or application for a lump-sum death payment.

Subpart I—Records of Earnings

General Provisions

404.801Introduction.
404.802Definitions.
404.803Conclusiveness of the record of your earnings.

Obtaining Earnings Information

404.810How to obtain a statement of earnings and a benefit estimate statement.
404.811The statement of earnings and benefit estimates you requested.
404.812Statement of earnings and benefit estimates sent without request.

Correcting the Earnings Record

404.820Filing a request for correction of the record of your earnings.
404.821Correction of the record of your earnings before the time limit ends.
404.822Correction of the record of your earnings after the time limit ends.
404.823Correction of the record of your earnings for work in the employ of the United States.

Notice of Removal or Reduction of an Entry of Earnings

404.830Notice of removal or reduction of your wages.
404.831Notice of removal or reduction of your self-employment income.

Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions

Introduction, Definitions, and Initial Determinations

404.900Introduction.
404.901Definitions.
404.902Administrative actions that are initial determinations.
404.903Administrative actions that are not initial determinations.
404.904Notice of the initial determination.
404.905Effect of an initial determination.
404.906Testing modifications to the disability determination procedures.

Reconsideration

404.907Reconsideration—general.
404.908Parties to a reconsideration.
404.909How to request reconsideration.
404.911Good cause for missing the deadline to request review.
404.913Reconsideration procedures.
404.914Disability hearing—general.
404.915Disability hearing—disability hearing officers.
404.916Disability hearing—procedures.
404.917Disability hearing—disability hearing officer's reconsidered determination.
404.918Disability hearing—review of the disability hearing officer's reconsidered determination before it is issued.
404.919Notice of another person's request for reconsideration.
404.920Reconsidered determination.
404.921Effect of a reconsidered determination.
404.922Notice of a reconsidered determination.

Expedited Appeals Process

404.923Expedited appeals process—general.
404.924When the expedited appeals process may be used.
404.925 How to request expedited appeals process.
404.926Agreement in expedited appeals process.
404.927Effect of expedited appeals process agreement.
404.928Expedited appeals process request that does not result in agreement.

Hearing Before an Administrative Law Judge

404.929Hearing before an administrative law judge—general.
404.930Availability of a hearing before an administrative law judge.
404.932Parties to a hearing before an administrative law judge.
404.933How to request a hearing before an administrative law judge.
404.935Submitting written evidence to an administrative law judge.
404.936Time and place for a hearing before an administrative law judge.
404.937Protecting the safety of the public and our employees in our hearing process.
404.938Notice of a hearing before an administrative law judge.
404.939Objections to the issues.
404.940Disqualification of the administrative law judge.
404.941Prehearing case review.
404.942Prehearing proceedings and decisions by attorney advisors.
404.943Responsibilities of the adjudication officer.

Administrative Law Judge Hearing Procedures

404.944Administrative law judge hearing procedures—general.
404.946Issues before an administrative law judge.
404.948Deciding a case without an oral hearing before an administrative law judge.
404.949Presenting written statements and oral arguments.
404.950Presenting evidence at a hearing before an administrative law judge.
404.951When a record of a hearing before an administrative law judge is made.
404.952Consolidated hearing before an administrative law judge.
404.953The decision of an administrative law judge.
404.955The effect of a hearing decision.
404.956Removal of a hearing request(s) to the Appeals Council.
404.957Dismissal of a request for a hearing before an administrative law judge.
404.958Notice of dismissal of a request for a hearing before an administrative law judge.
404.959Effect of dismissal of a request for a hearing before an administrative law judge.
404.960Vacating a dismissal of a request for a hearing before an administrative law judge.
404.961Prehearing and posthearing conferences.
404.965[Reserved]

Appeals Council Review

404.966[Reserved]
404.967Appeals Council review—general.
404.968How to request Appeals Council review.
404.969Appeals Council initiates review.
404.970Cases the Appeals Council will review.
404.971Dismissal by Appeals Council.
404.972Effect of dismissal of request for Appeals Council review.
404.973Notice of Appeals Council review.
404.974Obtaining evidence from Appeals Council.
404.975Filing briefs with the Appeals Council.
404.976Procedures before Appeals Council on review.
404.977Case remanded by Appeals Council.
404.979Decision of Appeals Council.
404.981Effect of Appeals Council's decision or denial of review.
404.982Extension of time to file action in Federal district court.

Court Remand Cases

404.983Case remanded by a Federal court.
404.984Appeals Council review of hearing decision in a case remanded by a Federal court.
404.985Application of circuit court law.

Reopening and Revising Determinations and Decisions

404.987Reopening and revising determinations and decisions.
404.988Conditions for reopening.
404.989Good cause for reopening.
404.990Finality of determinations and decisions on revision of an earnings record.
404.991Finality of determinations and decisions to suspend benefit payments for entire taxable year because of earnings.
404.991aLate completion of timely investigation.
404.992Notice of revised determination or decision.
404.993Effect of revised determination or decision.
404.994Time and place to request a hearing on revised determination or decision.
404.995Finality of findings when later claim is filed on same earnings record.
404.996Increase in future benefits where time period for reopening expires.

Payment of Certain Travel Expenses

404.999a Payment of certain travel expenses—general.
404.999bWho may be reimbursed.
404.999cWhat travel expenses are reimbursable.
404.999dWhen and how to claim reimbursement.

Subpart K—Employment, Wages, Self-Employment, and Self-Employment Income

404.1001Introduction.
404.1002Definitions.

Employment

404.1003Employment.
404.1004What work is covered as employment?
404.1005Who is an employee.
404.1006Corporation officer.
404.1007Common-law employee.
404.1008Agent-driver or commission-driver, full-time life insurance salesman, home worker, or traveling or city salesman.
404.1009Who is an employer.
404.1010Farm crew leader as employer.

Work Excluded From Employment

404.1012Work excluded from employment.
404.1013Included-excluded rule.
404.1014Domestic service by a student for a local college club, fraternity or sorority.
404.1015Family services.
404.1016Foreign agricultural workers.
404.1017Sharefarmers.
404.1018Work by civilians for the United States Government or its instrumentalities—wages paid after 1983.
404.1018aWork by civilians for the United States Government or its instrumentalities—remuneration paid prior to 1984.
404.1018bMedicare qualified government employment.
404.1019Work as a member of a uniformed service of the United States.
404.1020Work for States and their political subdivisions and instrumentalities.
404.1021Work for the District of Columbia.
404.1022American Samoa, Guam, or the Commonwealth of the Northern Mariana Islands.
404.1023Ministers of churches and members of religious orders.
404.1024Election of coverage by religious orders.
404.1025Work for religious, charitable, educational, or certain other organizations exempt from income tax.
404.1026Work for a church or qualified church-controlled organization.
404.1027Railroad work.
404.1028Student working for a school, college, or university.
404.1029Student nurses.
404.1030Delivery and distribution or sale of newspapers, shopping news, and magazines.
404.1031Fishing.
404.1032Work for a foreign government.
404.1033Work for a wholly owned instrumentality of a foreign government.
404.1034Work for an international organization.
404.1035Work for a communist organization.
404.1036Certain nonresident aliens.
404.1037Work on or in connection with a non-American vessel or aircraft.
404.1038Domestic employees under age 18.

Exemption From Social Security by Reason of Religous Belief

404.1039Employers (including partnerships) and employees who are both members of certain religious groups opposed to insurance.

Wages

404.1041Wages.
404.1042Wages when paid and received.
404.1043Facilities or privileges—meals and lodging.
404.1044Vacation pay.
404.1045Employee expenses.
404.1046Pay for work by certain members of religious orders.
404.1047Annual wage limitation.
404.1048Contribution and benefit base after 1992.
404.1049Payments under an employer plan or system.
404.1050Retirement payments.
404.1051Payments on account of sickness or accident disability, or related medical or hospitalization expenses.
404.1052Payments from or to certain tax-exempt trusts or payments under or into certain annuity plans.
404.1053“Qualified benefits” under a cafeteria plan.
404.1054Payments by an employer of employee's tax or employee's contribution under State law.
404.1055Payments for agricultural labor.
404.1056Explanation of agricultural labor.
404.1057Domestic service in the employer's home.
404.1058Special situations.
404.1059Deemed wages for certain individuals interned during World War II.
404.1060[Reserved]

Self-Employment

404.1065Self-employment coverage.
404.1066Trade or business in general.
404.1068Employees who are considered self-employed.
404.1069Real estate agents and direct sellers.
404.1070Christian Science practitioners.
404.1071Ministers and members of religious orders.
404.1073 Public office.
404.1074Farm crew leader who is self-employed.
404.1075Members of certain religious groups opposed to insurance.
404.1077Individuals under railroad retirement system.

Self-Employment Income

404.1080Net earnings from self-employment.
404.1081General rules for figuring net earnings from self-employment.
404.1082Rentals from real estate; material participation.
404.1083Dividends and interest.
404.1084Gain or loss from disposition of property; capital assets; timber, coal, and iron ore; involuntary conversion.
404.1085Net operating loss deduction.
404.1086Community income.
404.1087Figuring partner's net earnings from self-employment for taxable year which ends as a result of death.
404.1088Retirement payment to retired partners.
404.1089Figuring net earnings for residents and nonresidents of Puerto Rico.
404.1090Personal exemption deduction.
404.1091Figuring net earnings for ministers and members of religious orders.
404.1092Figuring net earnings for U.S. citizens or residents living outside the United States.
404.1093Possession of the United States.
404.1094Options available for figuring net earnings from self-employment.
404.1095Agricultural trade or business.
404.1096Self-employment income.

Subpart L [Reserved]

Subpart M—Coverage of Employees of State and Local Governments

General

404.1200General.
404.1201Scope of this subpart regarding coverage and wage reports and adjustments.
404.1202Definitions.
404.1203Evidence—for wages paid prior to 1987.
404.1204Designating officials to act on behalf of the State.

What Groups of Employees May Be Covered

404.1205Absolute coverage groups.
404.1206Retirement system coverage groups.
404.1207Divided retirement system coverage groups.
404.1208Ineligible employees.
404.1209Mandatorily excluded services.
404.1210Optionally excluded services.
404.1211Interstate instrumentalities.
404.1212Police officers and firefighters.

How Coverage Under Agreements Is Obtained and Continues

404.1214Agreement for coverage.
404.1215Modification of agreement.
404.1216Modification of agreement to correct an error.
404.1217Continuation of coverage.
404.1218Resumption of coverage.
404.1219Dissolution of political subdivision.

How To Identify Covered Employees

404.1220Identification numbers.

What Records of Coverage Must Be Kept

404.1225Records—for wages paid prior to 1987.

Review of Compliance by State With Its Agreement

404.1230Onsite review program.
404.1231Scope of review.
404.1232Conduct of review.
404.1234Reports of review's findings.

How To Report Wages and Contributions—for Wages Paid Prior to 1987

404.1237Wage reports and contribution returns—general—for wages paid prior to 1987.
404.1239Wage reports for employees performing services in more than one coverage group—for wages paid prior to 1987.
404.1242Back pay.
404.1243Use of reporting forms—for wages paid prior to 1987.
404.1247When to report wages—for wages paid prior to 1987.
404.1249When and where to make deposits of contributions and to file contribution returns and wage reports—for wages paid prior to 1987.
404.1251Final reports—for wages paid prior to 1987.

What Is a State's Liability for Contributions—for Wages Paid Prior to 1987

404.1255State's liability for contributions—for wages paid prior to 1987.
404.1256Limitation on State's liability for contributions for multiple employment situations—for wages paid prior to 1987.

Figuring the Amount of the State's Contributions—for Wages Paid Prior to 1987

404.1260Amount of contributions—for wages paid prior to 1987.
404.1262Manner of payment of contributions by State—for wages paid prior to 1987.
404.1263When fractional part of a cent may be disregarded—for wages paid prior to 1987.

If a State Fails To Make Timely Payments—for Wages Paid Prior to 1987

404.1265Addition of interest to contributions—for wages paid prior to 1987.
404.1267Failure to make timely payments—for wages paid prior to 1987.

How Errors in Reports and Contributions Are Adjusted—for Wages Paid Prior to 1987

404.1270Adjustments in general—for wages paid prior to 1987.
404.1271Adjustment of overpayment of contributions—for wages paid prior to 1987.
404.1272Refund or recomputation of overpayments which are not adjustable—for wages paid prior to 1987.
404.1275Adjustment of employee contributions—for wages paid prior to 1987.
404.1276Reports and payments erroneously made to Internal Revenue Service-transfer of funds—for wages paid prior to 1987.

How Overpayments of Contributions Are Credited or Refunded—for Wages Paid Prior to 1987

404.1280Allowance of credits or refunds—for wages paid prior to 1987.
404.1281Credits or refunds for periods of time during which no liability exists—for wages paid prior to 1987.
404.1282Time limitations on credits or refunds—for wages paid prior to 1987.
404.1283Exceptions to the time limitations on credits or refunds—for wages paid prior to 1987.
404.1284Offsetting underpayments against overpayments—for wages paid prior to 1987.

How Assessments for Underpayments of Contributions Are Made—for Wages Paid Prior to 1987

404.1285Assessments of amounts due—for wages paid prior to 1987.
404.1286Time limitations on assessments—for wages paid prior to 1987.
404.1287Exceptions to the time limitations on assessments—for wages paid prior to 1987.
404.1289Payment after expiration of time limitation for assessment—for wages paid prior to 1987.

Secretary's Review of Decisions on Credits, Refunds, or Assessments—for Wages Paid Prior to 1987

404.1290Review of decisions by the Secretary—for wages paid prior to 1987.
404.1291Reconsideration—for wages paid prior to 1987.
404.1292How to request review—for wages paid prior to 1987.
404.1293Time for filing request for review—for wages paid prior to 1987.
404.1294Notification to State after reconsideration—for wages paid prior to 1987.
404.1295Commissioner's review—for wages paid prior to 1987.
404.1296Commissioner's notification to the State—for wages paid prior to 1987.

How a State May Seek Court Review of Secretary's Decision—for Wages Paid Prior to 1987

404.1297Review by court—for wages paid prior to 1987.
404.1298Time for filing civil action—for wages paid prior to 1987.
404.1299Final judgments—for wages paid prior to 1987.

Subpart N—Wage Credits for Veterans and Members of the Uniformed Services

General

404.1301Introduction.
404.1302Definitions.

World War II Veterans

404.1310Who is a World War II veteran.
404.1311Ninety-day active service requirement for World War II veterans.
404.1312World War II service included.
404.1313World War II service excluded.

Post-World War II Veterans

404.1320Who is a post-World War II veteran.
404.1321Ninety-day active service requirement for post-World War II veterans.
404.1322Post-World War II service included.
404.1323Post-World War II service excluded.

Separation From Active Service

404.1325Separation from active service under conditions other than dishonorable.

Members of the Uniformed Services

404.1330Who is a member of a uniformed service.

Amounts of Wage Credits and Limits on Their Use

404.1340Wage credits for World War II and post-World War II veterans.
404.1341Wage credits for a member of a uniformed service.
404.1342Limits on granting World War II and post-World War II wage credits.
404.1343When the limits on granting World War II and post-World War II wage credits do not apply.

Deemed Insured Status for World War II Veterans

404.1350Deemed insured status.
404.1351 When deemed insured status does not apply.
404.1352Benefits and payments based on deemed insured status.

Effect of Other Benefits on Payment of Social Security Benefits and Payments

404.1360Veterans Administration pension or compensation payable.
404.1361Federal benefit payable other than by Veterans Administration.
404.1362Treatment of social security benefits or payments where Veterans Administration pension or compensation payable.
404.1363Treatment of social security benefits or payments where Federal benefit payable other than by Veterans Administration.

Evidence of Active Service and Membership in a Uniformed Service

404.1370Evidence of active service and separation from active service.
404.1371Evidence of membership in a uniformed service during the years 1957 through 1967.

Subpart O—Interrelationship of Old-Age, Survivors and Disability Insurance Program With the Railroad Retirement Program

404.1401What is the interrelationship between the Railroad Retirement Act and the Old-Age, Survivors and Disability Insurance Program of the Social Security Act?
404.1402When are railroad industry services by a non-vested worker covered under Social Security?
404.1404Effective date of coverage of railroad services under the act.
404.1405If you have been considered a non-vested worker, what are the situations when your railroad industry work will not be covered under Social Security?
404.1406Eligibility to railroad retirement benefits as a bar to payment of social security benefits.
404.1407When railroad retirement benefits do not bar payment of social security benefits.
404.1408Compensation to be treated as wages.
404.1409Purposes of using compensation.
404.1410Presumption on basis of certified compensation record.
404.1412Compensation quarters of coverage.
404.1413When will we certify payment to the Railroad Retirement Board (RRB)?

Subpart P—Determining Disability and Blindness

General

404.1501Scope of subpart.
404.1502General definitions and terms for this subpart.

Determinations

404.1503Who makes disability and blindness determinations.
404.1503aProgram integrity.
404.1503bEvidence from excluded medical sources of evidence.
404.1504Determinations by other government agencies and nongovernmental entities.

Definition of Disability

404.1505Basic definition of disability.
404.1506When we will not consider your impairment.
404.1508[Reserved]
404.1509How long the impairment must last.
404.1510Meaning of substantial gainful activity.
404.1511Definition of disabling impairment.

Evidence

404.1512Responsibility for evidence.
404.1513Categories of evidence.
404.1513aEvidence from our Federal or State agency medical or psychological consultants.
404.1514When we will purchase existing evidence.
404.1515Where and how to submit evidence.
404.1516If you fail to submit medical and other evidence.
404.1517Consultative examination at our expense.
404.1518If you do not appear at a consultative examination.

Standards To Be Used in Determining When a Consultative Examination Will Be Obtained in Connection With Disability Determinations

404.1519The consultative examination.
404.1519aWhen we will purchase a consultative examination and how we will use it.
404.1519bWhen we will not purchase a consultative examination.

Standards for the Type of Referral and for Report Content

404.1519fType of purchased examinations.
404.1519gWho we will select to perform a consultative examination.
404.1519hYour medical source.
404.1519iOther sources for consultative examinations.
404.1519jObjections to the medical source designated to perform the consultative examination.
404.1519kPurchase of medical examinations, laboratory tests, and other services.
404.1519m Diagnostic tests or procedures.
404.1519nInforming the medical source of examination scheduling, report content, and signature requirements.
404.1519oWhen a properly signed consultative examination report has not been received.
404.1519pReviewing reports of consultative examinations.
404.1519qConflict of interest.

Authorizing and Monitoring the Referral Process

404.1519sAuthorizing and monitoring the consultative examination.

Procedures To Monitor the Consultative Examination

404.1519tConsultative examination oversight.

Evaluation of Disability

404.1520Evaluation of disability in general.
404.1520aEvaluation of mental impairments.
404.1520bHow we consider evidence.
404.1520cHow we consider and articulate medical opinions and prior administrative medical findings for claims filed on or after March 27, 2017.
404.1521Establishing that you have a medically determinable impairment(s).
404.1522What we mean by an impairment(s) that is not severe.
404.1523Multiple impairments.

Medical Considerations

404.1525Listing of Impairments in appendix 1.
404.1526Medical equivalence.
404.1527Evaluating opinion evidence for claims filed before March 27, 2017.
404.1528[Reserved]
404.1529How we evaluate symptoms, including pain.
404.1530Need to follow prescribed treatment.
404.1535How we will determine whether your drug addiction or alcoholism is a contributing factor material to the determination of disability.
404.1536Treatment required for individuals whose drug addiction or alcoholism is a contributing factor material to the determination of disability.
404.1537What we mean by appropriate treatment.
404.1538What we mean by approved institutions or facilities.
404.1539How we consider whether treatment is available.
404.1540Evaluating compliance with the treatment requirements.
404.1541Establishment and use of referral and monitoring agencies.

Residual Functional Capacity

404.1545Your residual functional capacity.
404.1546Responsibility for assessing your residual functional capacity.

Vocational Considerations

404.1560When we will consider your vocational background.
404.1562Medical-vocational profiles showing an inability to make an adjustment to other work.
404.1563Your age as a vocational factor.
404.1564Your education as a vocational factor.
404.1565Your work experience as a vocational factor.
404.1566Work which exists in the national economy.
404.1567Physical exertion requirements.
404.1568Skill requirements.
404.1569Listing of Medical-Vocational Guidelines in appendix 2.
404.1569aExertional and nonexertional limitations.

Substantial Gainful Activity

404.1571General.
404.1572What we mean by substantial gainful activity.
404.1573General information about work activity.
404.1574Evaluation guides if you are an employee.
404.1574aWhen and how we will average your earnings.
404.1575Evaluation guides if you are self-employed.
404.1576Impairment-related work expenses.

Widows, Widowers, and Surviving Divorced Spouses

404.1577Disability defined for widows, widowers, and surviving divorced spouses for monthly benefits payable for months prior to January 1991.
404.1578How we determine disability for widows, widowers, and surviving divorced spouses for monthly benefits payable for months prior to January 1991.
404.1579How we will determine whether your disability continues or ends.

Blindness

404.1581Meaning of blindness as defined in the law.
404.1582A period of disability based on blindness.
404.1583How we determine disability for blind persons who are age 55 or older.
404.1584Evaluation of work activity of blind people.
404.1585Trial work period for persons age 55 or older who are blind.
404.1586 Why and when we will stop your cash benefits.
404.1587Circumstances under which we may suspend and terminate your benefits before we make a determination.

Continuing or Stopping Disability

404.1588Your responsibility to tell us of events that may change your disability status.
404.1589We may conduct a review to find out whether you continue to be disabled.
404.1590When and how often we will conduct a continuing disability review.
404.1591If your medical recovery was expected and you returned to work.
404.1592The trial work period.
404.1592aThe reentitlement period.
404.1592bWhat is expedited reinstatement?
404.1592cWho is entitled to expedited reinstatement?
404.1592dHow do I request reinstatement?
404.1592eHow do we determine provisional benefits?
404.1592fHow do we determine reinstated benefits?
404.1593Medical evidence in continuing disability review cases.
404.1594How we will determine whether your disability continues or ends.
404.1595When we determine that you are not now disabled.
404.1596Circumstances under which we may suspend and terminate your benefits before we make a determination.
404.1597After we make a determination that you are not now disabled.
404.1597aContinued benefits pending appeal of a medical cessation determination.
404.1598If you become disabled by another impairment(s).
404.1599Work incentive experiments and rehabilitation demonstration projects in the disability program.
Appendix 1 to Subpart P of Part 404—Listing of Impairments
Appendix 2 to Subpart P of Part 404—Medical-Vocational Guidelines

Subpart Q—Determinations of Disability

General Provisions

404.1601Purpose and scope.
404.1602Definitions.
404.1603Basic responsibilities for us and the State.

Responsibilities for Performing the Disability Determination Function

404.1610How a State notifies us that it wishes to perform the disability determination function.
404.1611How we notify a State whether it may perform the disability determination function.
404.1613Disability determinations the State makes.
404.1614Responsibilities for obtaining evidence to make disability determinations.
404.1615Making disability determinations.
404.1616Medical consultants and psychological consultants.
404.1617Reasonable efforts to obtain review by a physician, psychiatrist, and psychologist.
404.1618Notifying claimants of the disability determination.

Quick Disability Determinations

404.1619Quick disability determination process.

Administrative Responsibilities and Requirements

404.1620General administrative requirements.
404.1621Personnel.
404.1622Training.
404.1623Facilities.
404.1624Medical and other purchased services.
404.1625Records and reports.
404.1626Fiscal.
404.1627Audits.
404.1628Property.
404.1629Participation in research and demonstration projects.
404.1630Coordination with other agencies.
404.1631Confidentiality of information and records.
404.1632Other Federal laws and regulations.
404.1633Policies and operating instructions.

Performance Standards

404.1640General.
404.1641Standards of performance.
404.1642Processing time standards.
404.1643Performance accuracy standard.
404.1644How and when we determine whether the processing time standards are met.
404.1645How and when we determine whether the performance accuracy standard is met.
404.1650Action we will take if a State agency does not meet the standards.

Performance Monitoring and Support

404.1660How we will monitor.
404.1661When we will provide performance support.
404.1662What support we will provide.

Substantial Failure

404.1670General.
404.1671Good cause for not following the Act, our regulations, or other written guidelines.
404.1675Finding of substantial failure.

Hearings and Appeals

404.1680 Notice of right to hearing on proposed finding of substantial failure.
404.1681Disputes on matters other than substantial failure.
404.1682Who conducts the hearings.
404.1683Hearings and appeals process.

Assumption of Disability Determination Function

404.1690Assumption when we make a finding of substantial failure.
404.1691Assumption when State no longer wishes to perform the disability determination function.
404.1692Protection of State employees.
404.1693Limitation on State expenditures after notice.
404.1694Final accounting by the State.

Subpart R—Representation of Parties

404.1700Introduction.
404.1703Definitions.
404.1705Who may be your representative.
404.1706Notification of options for obtaining attorney representation.
404.1707Appointing a representative.
404.1710Authority of a representative.
404.1713Mandatory use of electronic services.
404.1715Notice or request to a representative.
404.1717Direct payment of fees to eligible non-attorney representatives.
404.1720Fee for a representative's services.
404.1725Request for approval of a fee.
404.1728Proceedings before a State or Federal court.
404.1730Payment of fees.
404.1735[Reserved]
404.1740Rules of conduct and standards of responsibility for representatives.
404.1745Violations of our requirements, rules, or standards.
404.1750Notice of charges against a representative.
404.1755Withdrawing charges against a representative.
404.1765Hearing on charges.
404.1770Decision by hearing officer.
404.1775Requesting review of the hearing officer's decision.
404.1776Assignment of request for review of the hearing officer's decision.
404.1780Appeals Council's review of hearing officer's decision.
404.1785Evidence permitted on review.
404.1790Appeals Council's decision.
404.1795When the Appeals Council will dismiss a request for review.
404.1797Reinstatement after suspension—period of suspension expired.
404.1799Reinstatement after suspension or disqualification—period of suspension not expired.

Subpart S—Payment Procedures

404.1800Introduction.
404.1805Paying benefits.
404.1807Monthly payment day.
404.1810Expediting benefit payments.
404.1815Withholding certification or payments.
404.1820Transfer or assignment of payments.
404.1821Garnishment of payments after disbursement.
404.1825Joint payments to a family.

Subpart T—Totalization Agreements

General Provisions

404.1901Introduction.
404.1902Definitions.
404.1903Negotiating totalization agreements.
404.1904Effective date of a totalization agreement.
404.1905Termination of agreements.

Benefit Provisions

404.1908Crediting foreign periods of coverage.
404.1910Person qualifies under more than one totalization agreement.
404.1911Effects of a totalization agreement on entitlement to hospital insurance benefits.

Coverage Provisions

404.1913Precluding dual coverage.
404.1914Certificate of coverage.
404.1915Payment of contributions.

Computation Provisions

404.1918How benefits are computed.
404.1919How benefits are recomputed.
404.1920Supplementing the U.S. benefit if the total amount of the combined benefits is less than the U.S. minimum benefit.
404.1921Benefits of less than $1 due.

Other Provisions

404.1925Applications.
404.1926Evidence.
404.1927Appeals.
404.1928Effect of the alien non-payment provision.
404.1929Overpayments.
404.1930Disclosure of information.

Subpart U—Representative Payment

404.2001Introduction.
404.2010When payment will be made to a representative payee.
404.2011What happens to your monthly benefits while we are finding a suitable representative payee for you?
404.2015 Information considered in determining whether to make representative payments.
404.2018Advance designation of representative payees.
404.2020Information considered in selecting a representative payee.
404.2021What is our order of preference in selecting a representative payee for you?
404.2022Who may not serve as a representative payee?
404.2024How do we investigate a representative payee applicant?
404.2025What information must a representative payee report to us?
404.2026How do we investigate an appointed representative payee?
404.2030How will we notify you when we decide you need a representative payee?
404.2035What are the responsibilities of your representative payee?
404.2040Use of benefit payments.
404.2040aCompensation for qualified organizations serving as representative payees.
404.2041Who is liable if your representative payee misuses your benefits?
404.2045Conservation and investment of benefit payments.
404.2050When will we select a new representative payee for you?
404.2055When representative payment will be stopped.
404.2060Transfer of accumulated benefit payments.
404.2065How does your representative payee account for the use of benefits?

Subpart V—Payments for Vocational Rehabilitation Services

General Provisions

404.2101General.
404.2102Purpose and scope.
404.2103Definitions.
404.2104Participation by State VR agencies.
404.2106[Reserved]

Payment Provisions

404.2108Requirements for payment.
404.2109Responsibility for making payment decisions.
404.2110What we mean by “SGA” and by “a continuous period of 9 months”.
404.2111Criteria for determining when VR services will be considered to have contributed to a continuous period of 9 months.
404.2112Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program.
404.2114Services for which payment may be made.
404.2115When services must have been provided.
404.2116When claims for payment for VR services must be made (filing deadlines).
404.2117What costs will be paid.

Administrative Provisions

404.2118[Reserved]
404.2119Method of payment.
404.2120Audits.
404.2121Validation reviews.
404.2122Confidentiality of information and records.
404.2123Other Federal laws and regulations.
404.2127Resolution of disputes.