Background

This transmittal amends section I-5-6 of the Hearings, Appeals, and Litigation Law (HALLEX) manual to update our policies and instructions based on the recission of Social Security Ruling (SSR) 16-1p: Titles II and XVI: Fraud and Similar Fault Redeterminations Under Sections 205(u) and 1631(e)(7) of the Social Security Act and SSR 16-2p: Titles II and XVI: Evaluation of Claims Involving the Issue of Similar Fault in the Providing of Evidence, and the publication of SSR 22-1p: Titles II and XVI: Fraud and Similar Fault Redeterminations Under Sections 205(u) and 1631(e)(7) of the Social Security Act and SSR 22-2p: Titles II and XVI: Evaluation of Claims Involving the Issue of Similar Fault in the Providing of Evidence.

Explanation of Content and Changes

I-5-6-3 – We removed obsolete instructions in subsections II., III., and IV related to SSRs 16-1p and 16-2p, and we replaced them with revised instructions consistent with SSRs 22-1p and 22-2p. We added information in subsections II., III., and IV. to clarify that before the agency disregards evidence in redetermination cases, an adjudicator must make a finding regarding whether there is reason to believe that fraud or similar fault was involved in the providing of evidence in support of the individual's application. If the adjudicator finds there is a reason to believe that fraud or similar fault was involved in the providing of evidence, the adjudicator must provide the individual an opportunity to object to the disregarding of the evidence at the hearings level under SSRs 22-1p and 22-2p before disregarding the evidence. We added additional instructions in subsections III. and IV. whereby if the adjudicator does not find reason to believe that fraud or similar fault was involved in the providing of evidence, and therefore does not disregard any evidence, then the adjudicator may not proceed with the redetermination and must issue a fully favorable decision to reinstate the prior allowance. We reorganized subsections III. and IV. to reflect these changes in case processing.

We added instructions in subsection III. explaining the reason to believe standard (with a cross reference to HALLEX I- 1-3-15 C.1.), the exhibiting disregarded evidence, and the appropriate period of adjudication in redetermination decisions. We updated the decisional language in subsections III. and IV. to comport with the new SSRs 22-1p and 22-2p. In subsection IV., we added instructions explaining exhibiting disregarded evidence and updated Appeals Council actions when processing requests for review of redetermination cases involving fraud or similar fault. We also replaced and updated references to SSRs 16-1p and 16-2p with references to SSRs 22-1p and 22-2p throughout. We added references to the Electronic Non-Medical (ENM) application. We provided an updated mailing address for the Special Review Cadre (SRC). We made minor editorial changes for readability throughout the section.

We removed the Screening Worksheet under Attachment 4 because the screening process at the hearings level has changed, and the screening sheet is no longer needed. We added a Notice of Redetermination under Attachment 4 for cases involving redetermination of the original allowances that were issued at the hearings level. We updated Attachment 5 with an updated Notice of Hearing. We removed Attachment 6 because it related to original allowances that were issued at the Appeals Council level that required redetermination, and these cases have since been redetermined.

I-5-6-8 – We removed obsolete instructions in subsections II., III., and IV related to SSRs 16-1p and 16-2p, and we replaced them with revised instructions consistent with SSRs 22-1p and 22-2p. We added information in subsections II., III., and IV. to clarify that before the agency disregards evidence in redetermination cases, an adjudicator must make a finding regarding whether there is reason to believe that fraud or similar fault was involved in the providing of evidence in support of the individual's application. If the adjudicator finds there is a reason to believe that fraud or similar fault was involved in the providing of evidence, the adjudicator must provide the individual an opportunity to object to the disregarding of the evidence at the hearings level under SSRs 22-1p and 22-2p before disregarding the evidence. We added additional instructions in subsections III. and IV. whereby if the adjudicator does not find reason to believe that fraud or similar fault was involved in the providing of evidence, and therefore does not disregard any evidence, then the adjudicator may not proceed with the redetermination and must issue a fully favorable decision to reinstate the prior allowance. We reorganized subsections III. and IV. to reflect these changes in case processing.

We added instructions in subsection III. explaining the reason to believe standard (with a cross reference to HALLEX I- 1-3-15 C.1.), the exhibiting disregarded evidence, and the appropriate period of adjudication in redetermination decisions. We updated the decisional language in subsections III. and IV. to comport with the new SSRs 22-1p and 22-2p. In subsection IV., we added instructions explaining exhibiting disregarded evidence and updated Appeals Council actions when processing requests for review of redetermination cases involving fraud or similar fault. We also replaced and updated references to SSRs 16-1p and 16-2p with references to SSRs 22-1p and 22-2p throughout. We added references to the Electronic Non-Medical (ENM) application. We provided an updated mailing address for the Special Review Cadre (SRC). We made minor editorial changes for readability throughout the section.

We removed the Screening Worksheet under Attachment 4 because the screening process at the hearings level has changed, and the screening sheet is no longer needed. We added a Notice of Redetermination under Attachment 4 for cases involving redetermination of the original allowances that were issued at the hearings level. We updated Attachment 5 with an updated Notice of Hearing. We removed Attachment 6 because it related to original allowances that were issued at the Appeals Council level that required redetermination, and these cases have since been redetermined.

Date: July 31, 2023