Part B—Procedural and General Provisions
§1383. Procedure for payment of benefits
(a) Time, manner, form, and duration of payments; representative payees; promulgation of regulations
(1) Benefits under this subchapter shall be paid at such time or times and (subject to paragraph (10)) in such installments as will best effectuate the purposes of this subchapter, as determined under regulations (and may in any case be paid less frequently than monthly where the amount of the monthly benefit would not exceed $10).
(2)(A)(i) Payments of the benefit of any individual may be made to any such individual or to the eligible spouse (if any) of such individual or partly to each.
(ii)(I) Upon a determination by the Commissioner of Social Security that the interest of such individual would be served thereby, such payments shall be made, regardless of the legal competency or incompetency of the individual or eligible spouse, to another individual, or an organization, with respect to whom the requirements of subparagraph (B) have been met (in this paragraph referred to as such individual's "representative payee") for the use and benefit of the individual or eligible spouse.
(II) In the case of an individual eligible for benefits under this subchapter by reason of disability, the payment of such benefits shall be made to a representative payee if the Commissioner of Social Security determines that such payment would serve the interest of the individual because the individual also has an alcoholism or drug addiction condition (as determined by the Commissioner) and the individual is incapable of managing such benefits.
(iii) If the Commissioner of Social Security or a court of competent jurisdiction determines that the representative payee of an individual or eligible spouse has misused any benefits which have been paid to the representative payee pursuant to clause (ii) or
(iv) For purposes of this paragraph, misuse of benefits by a representative payee occurs in any case in which the representative payee receives payment under this subchapter for the use and benefit of another person and converts such payment, or any part thereof, to a use other than for the use and benefit of such other person. The Commissioner of Social Security may prescribe by regulation the meaning of the term "use and benefit" for purposes of this clause.
(B)(i) Any determination made under subparagraph (A) for payment of benefits to the representative payee of an individual or eligible spouse shall be made on the basis of—
(I) an investigation by the Commissioner of Social Security of the person to serve as representative payee, which shall be conducted in advance of such payment, and shall, to the extent practicable, include a face-to-face interview with such person; and
(II) adequate evidence that such payment is in the interest of the individual or eligible spouse (as determined by the Commissioner of Social Security in regulations).
(ii) As part of the investigation referred to in clause (i)(I), the Commissioner of Social Security shall—
(I) require the person being investigated to submit documented proof of the identity of such person, unless information establishing such identity was submitted with an application for benefits under subchapter II, subchapter VIII, or this subchapter;
(II) verify the social security account number (or employer identification number) of such person;
(III) determine whether such person has been convicted of a violation of
(IV) obtain information concerning whether the person has been convicted of any other offense under Federal or State law which resulted in imprisonment for more than 1 year;
(V) obtain information concerning whether such person is a person described in
(VI) determine whether payment of benefits to such person has been terminated pursuant to subparagraph (A)(iii), whether the designation of such person as a representative payee has been revoked pursuant to
(VII) determine whether such person has been convicted (and not subsequently exonerated), under Federal or State law, of a felony provided under clause (xv), or of an attempt or a conspiracy to commit such a felony.
(iii) Benefits of an individual may not be paid to any other person pursuant to subparagraph (A)(ii) if—
(I) such person has previously been convicted as described in clause (ii)(III);
(II) except as provided in clause (iv), payment of benefits to such person pursuant to subparagraph (A)(ii) has previously been terminated as described in clause (ii)(VI), the designation of such person as a representative payee has been revoked pursuant to
(III) except as provided in clause (v), such person is a creditor of such individual who provides such individual with goods or services for consideration;
(IV) the person has previously been convicted as described in clause (ii)(IV) of this subparagraph, unless the Commissioner determines that the payment would be appropriate notwithstanding the conviction;
(V) such person is a person described in
(VI) except as provided in clause (xvii), such person has previously been convicted (and not subsequently exonerated) as described in clause (ii)(VII), or
(VII) such person's benefits under this subchapter, subchapter II, or subchapter VIII are certified for payment to a representative payee during the period for which the individual's benefits would be certified for payment to another person.
(iv) The Commissioner of Social Security shall prescribe regulations under which the Commissioner of Social Security may grant an exemption from clause (iii)(II) to any person on a case-by-case basis if such exemption would be in the best interest of the individual or eligible spouse whose benefits under this subchapter would be paid to such person pursuant to subparagraph (A)(ii).
(v) Clause (iii)(III) shall not apply with respect to any person who is a creditor referred to therein if such creditor is—
(I) a relative of such individual if such relative resides in the same household as such individual;
(II) a legal guardian or legal representative of such individual;
(III) a facility that is licensed or certified as a care facility under the law of a State or a political subdivision of a State;
(IV) a person who is an administrator, owner, or employee of a facility referred to in subclause (III) if such individual resides in such facility, and the payment of benefits under this subchapter to such facility or such person is made only after good faith efforts have been made by the local servicing office of the Social Security Administration to locate an alternative representative payee to whom the payment of such benefits would serve the best interests of such individual; or
(V) an individual who is determined by the Commissioner of Social Security, on the basis of written findings and under procedures which the Commissioner of Social Security shall prescribe by regulation, to be acceptable to serve as a representative payee.
(vi) The procedures referred to in clause (v)(V) shall require the individual who will serve as representative payee to establish, to the satisfaction of the Commissioner of Social Security, that—
(I) such individual poses no risk to the beneficiary;
(II) the financial relationship of such individual to the beneficiary poses no substantial conflict of interest; and
(III) no other more suitable representative payee can be found.
(vii) In the case of an individual described in subparagraph (A)(ii)(II), when selecting such individual's representative payee, preference shall be given to—
(I) a certified community-based nonprofit social service agency (as defined in subparagraph (I));
(II) a Federal, State, or local government agency whose mission is to carry out income maintenance, social service, or health care-related activities;
(III) a State or local government agency with fiduciary responsibilities; or
(IV) a designee of an agency (other than of a Federal agency) referred to in the preceding subclauses of this clause, if the Commissioner of Social Security deems it appropriate,
unless the Commissioner of Social Security determines that selection of a family member would be appropriate.
(viii) Subject to clause (ix), if the Commissioner of Social Security makes a determination described in subparagraph (A)(ii) with respect to any individual's benefit and determines that direct payment of the benefit to the individual would cause substantial harm to the individual, the Commissioner of Social Security may defer (in the case of initial entitlement) or suspend (in the case of existing entitlement) direct payment of such benefit to the individual, until such time as the selection of a representative payee is made pursuant to this subparagraph.
(ix)(I) Except as provided in subclause (II), any deferral or suspension of direct payment of a benefit pursuant to clause (viii) shall be for a period of not more than 1 month.
(II) Subclause (I) shall not apply in any case in which the individual or eligible spouse is, as of the date of the Commissioner's determination, legally incompetent, under the age of 15 years, or described in subparagraph (A)(ii)(II).
(x) Payment pursuant to this subparagraph of any benefits which are deferred or suspended pending the selection of a representative payee shall be made to the individual, or to the representative payee upon such selection, as a single sum or over such period of time as the Commissioner of Social Security determines is in the best interests of the individual entitled to such benefits.
(xi) Any individual who is dissatisfied with a determination by the Commissioner of Social Security to pay such individual's benefits to a representative payee under this subchapter, or with the designation of a particular person to serve as representative payee, shall be entitled to a hearing by the Commissioner of Social Security, and to judicial review of the Commissioner's final decision, to the same extent as is provided in subsection (c).
(xii) In advance of the first payment of an individual's benefit to a representative payee under subparagraph (A)(ii), the Commissioner of Social Security shall provide written notice of the Commissioner's initial determination to make any such payment. Such notice shall be provided to such individual, except that, if such individual—
(I) is under the age of 15,
(II) is an unemancipated minor under the age of 18, or
(III) is legally incompetent,
then such notice shall be provided solely to the legal guardian or legal representative of such individual.
(xiii) Any notice described in clause (xii) shall be clearly written in language that is easily understandable to the reader, shall identify the person to be designated as such individual's representative payee, and shall explain to the reader the right under clause (xi) of such individual or of such individual's legal guardian or legal representative—
(I) to appeal a determination that a representative payee is necessary for such individual,
(II) to appeal the designation of a particular person to serve as the representative payee of such individual, and
(III) to review the evidence upon which such designation is based and submit additional evidence.
(xiv) Notwithstanding the provisions of
(I) such person is described in
(II) such person has information that is necessary for the officer to conduct the officer's official duties, and
(III) the location or apprehension of such person is within the officer's official duties.
(xv) The felony crimes provided under this clause, whether an offense under State or Federal law, are the following:
(I) Human trafficking, including as prohibited under
(II) False imprisonment, including as prohibited under
(III) Kidnapping, including as prohibited under
(IV) Rape and sexual assault, including as prohibited under
(V) First-degree homicide, including as prohibited under
(VI) Robbery, including as prohibited under
(VII) Fraud to obtain access to government assistance, including as prohibited under
(VIII) Fraud by scheme, including as prohibited under
(IX) Theft of government funds or property, including as prohibited under
(X) Abuse or neglect, including as prohibited under
(XI) Forgery, including as prohibited under section 642 and
(XII) Identity theft or identity fraud, including as prohibited under
The Commissioner of Social Security may promulgate regulations to provide for additional felony crimes under this clause.
(xvi)(I) For the purpose of carrying out the activities required under clause (ii) as part of the investigation under clause (i)(I), the Commissioner may conduct a background check of any individual seeking to serve as a representative payee under this subsection and may disqualify from service as a representative payee any such individual who fails to grant permission for the Commissioner to conduct such a background check.
(II) The Commissioner may revoke certification of payment of benefits under this subsection to any individual serving as a representative payee on or after January 1, 2019 who fails to grant permission for the Commissioner to conduct such a background check.
(xvii)(I) With respect to any person described in subclause (II)—
(aa) clause (ii)(VII) shall not apply; and
(bb) the Commissioner may grant an exemption from the provisions of clause (iii)(VI) if the Commissioner determines that such exemption is in the best interest of the individual entitled to benefits.
(II) A person is described in this subclause if the person—
(aa) is the custodial parent of a minor child for whom the person applies to serve;
(bb) is the custodial spouse of the beneficiary for whom the person applies to serve;
(cc) is the custodial parent of a beneficiary who is under a disability which began before the beneficiary attained the age of 22, for whom the person applies to serve;
(dd) is the custodial court appointed guardian of the beneficiary for whom the person applies to serve;
(ee) is the custodial grandparent of a minor grandchild for whom the person applies to serve;
(ff) is the parent who was previously representative payee for his or her minor child who has since turned 18 and continues to be eligible for such benefit; or
(gg) received a presidential or gubernatorial pardon for the relevant conviction.
(C)(i) In any case where payment is made under this subchapter to a representative payee of an individual or spouse, the Commissioner of Social Security shall establish a system of accountability monitoring whereby such person shall report not less often than annually with respect to the use of such payments. The Commissioner of Social Security shall establish and implement statistically valid procedures for reviewing such reports in order to identify instances in which such persons are not properly using such payments.
(ii) Clause (i) shall not apply in any case where the representative payee is a State institution. In such cases, the Commissioner of Social Security shall establish a system of accountability monitoring for institutions in each State.
(iii) Clause (i) shall not apply in any case where the individual entitled to such payment is a resident of a Federal institution and the representative payee is the institution.
(iv)(I) Clause (i) shall not apply in any case where the representative payee is—
(aa) a parent, or other individual who is a legal guardian of, a minor child entitled to such payment who primarily resides in the same household;
(bb) a parent of an individual entitled to such payment who is under a disability who primarily resides in the same household; or
(cc) the spouse of the individual entitled to such payment.
(II) The Commissioner of Social Security shall establish and implement procedures as necessary for the Commissioner to determine the eligibility of such parties for the exemption provided in subclause (I). The Commissioner shall prescribe such regulations as may be necessary to determine eligibility for such exemption.
(v) Notwithstanding clauses (i), (ii), (iii), and (iv), the Commissioner of Social Security may require a report at any time from any representative payee, if the Commissioner of Social Security has reason to believe that the representative payee is misusing such payments.
(vi) In any case in which the person described in clause (i) or (v) receiving payments on behalf of another fails to submit a report required by the Commissioner of Social Security under clause (i) or (v), the Commissioner may, after furnishing notice to the person and the individual entitled to the payment, require that such person appear in person at a field office of the Social Security Administration serving the area in which the individual resides in order to receive such payments.
(D)(i) Except as provided in the next sentence, a qualified organization may collect from an individual a monthly fee for expenses (including overhead) incurred by such organization in providing services performed as such individual's representative payee pursuant to subparagraph (A)(ii) if the fee does not exceed the lesser of—
(I) 10 percent of the monthly benefit involved, or
(II) $25.00 per month ($50.00 per month in any case in which an individual is described in subparagraph (A)(ii)(II)).
A qualified organization may not collect a fee from an individual for any month with respect to which the Commissioner of Social Security or a court of competent jurisdiction has determined that the organization misused all or part of the individual's benefit, and any amount so collected by the qualified organization for such month shall be treated as a misused part of the individual's benefit for purposes of subparagraphs (E) and (F). The Commissioner of Social Security shall adjust annually (after 1995) each dollar amount set forth in subclause (II) of this clause under procedures providing for adjustments in the same manner and to the same extent as adjustments are provided for under the procedures used to adjust benefit amounts under
(ii) For purposes of this subparagraph, the term "qualified organization" means any State or local government agency whose mission is to carry out income maintenance, social service, or health care-related activities, any State or local government agency with fiduciary responsibilities, or any certified community-based nonprofit social service agency (as defined in subparagraph (I)), if the agency, in accordance with any applicable regulations of the Commissioner of Social Security—
(I) regularly provides services as a representative payee pursuant to subparagraph (A)(ii) or
(II) demonstrates to the satisfaction of the Commissioner of Social Security that such agency is not otherwise a creditor of any such individual.
The Commissioner of Social Security shall prescribe regulations under which the Commissioner of Social Security may grant an exception from subclause (II) for any individual on a case-by-case basis if such exception is in the best interests of such individual.
(iii) Any qualified organization which knowingly charges or collects, directly or indirectly, any fee in excess of the maximum fee prescribed under clause (i) or makes any agreement, directly or indirectly, to charge or collect any fee in excess of such maximum fee, shall be fined in accordance with title 18, or imprisoned not more than 6 months, or both.
(iv) In the case of an individual who is no longer eligible for benefits under this subchapter but to whom any amount of past-due benefits under this subchapter has not been paid, for purposes of clause (i), any amount of such past-due benefits payable in any month shall be treated as a monthly benefit referred to in clause (i)(I).
(E)
(i) is not an individual (regardless of whether it is a "qualified organization" within the meaning of subparagraph (D)(ii)); or
(ii) is an individual who, for any month during a period when misuse occurs, serves 15 or more individuals who are beneficiaries under this subchapter, subchapter II, subchapter VIII, or any combination of such subchapters;
misuses all or part of an individual's benefit paid to such representative payee, the Commissioner of Social Security shall pay to the beneficiary or the beneficiary's alternative representative payee an amount equal to the amount of such benefit so misused. The provisions of this subparagraph are subject to the limitations of subparagraph (H)(ii). The Commissioner of Social Security shall make a good faith effort to obtain restitution from the terminated representative payee.
(F)(i)(I) Each representative payee of an eligible individual under the age of 18 who is eligible for the payment of benefits described in subclause (II) shall establish on behalf of such individual an account in a financial institution into which such benefits shall be paid, and shall thereafter maintain such account for use in accordance with clause (ii).
(II) Benefits described in this subclause are past-due monthly benefits under this subchapter (which, for purposes of this subclause, include State supplementary payments made by the Commissioner pursuant to an agreement under
(aa) 6, and
(bb) the maximum monthly benefit payable under this subchapter to an eligible individual.
(ii)(I) A representative payee shall use funds in the account established under clause (i) to pay for allowable expenses described in subclause (II).
(II) An allowable expense described in this subclause is an expense for—
(aa) education or job skills training;
(bb) personal needs assistance;
(cc) special equipment;
(dd) housing modification;
(ee) medical treatment;
(ff) therapy or rehabilitation; or
(gg) any other item or service that the Commissioner determines to be appropriate;
provided that such expense benefits such individual and, in the case of an expense described in item (bb), (cc), (dd), (ff), or (gg), is related to the impairment (or combination of impairments) of such individual.
(III) The use of funds from an account established under clause (i) in any manner not authorized by this clause—
(aa) by a representative payee shall be considered a misapplication of benefits for all purposes of this paragraph, and any representative payee who knowingly misapplies benefits from such an account shall be liable to the Commissioner in an amount equal to the total amount of such benefits; and
(bb) by an eligible individual who is his or her own payee shall be considered a misapplication of benefits for all purposes of this paragraph and in any case in which the individual knowingly misapplies benefits from such an account, the Commissioner shall reduce future benefits payable to such individual (or to such individual and his spouse) by an amount equal to the total amount of such benefits so misapplied.
(IV) This clause shall continue to apply to funds in the account after the child has reached age 18, regardless of whether benefits are paid directly to the beneficiary or through a representative payee.
(iii) The representative payee may deposit into the account established under clause (i) any other funds representing past due benefits under this subchapter to the eligible individual, provided that the amount of such past due benefits is equal to or exceeds the maximum monthly benefit payable under this subchapter to an eligible individual (including State supplementary payments made by the Commissioner pursuant to an agreement under
(iv) The Commissioner of Social Security shall establish a system for accountability monitoring whereby such representative payee shall report, at such time and in such manner as the Commissioner shall require, on activity respecting funds in the account established pursuant to clause (i).
(G)(i) In addition to such other reviews of representative payees as the Commissioner of Social Security may otherwise conduct, the Commissioner shall provide for the periodic onsite review of any person or agency that receives the benefits payable under this subchapter (alone or in combination with benefits payable under subchapter II or subchapter VIII) to another individual pursuant to the appointment of the person or agency as a representative payee under this paragraph,
(I) the representative payee is a person who serves in that capacity with respect to 15 or more such individuals;
(II) the representative payee is a certified community-based nonprofit social service agency (as defined in subparagraph (I) of this paragraph or
(III) the representative payee is an agency (other than an agency described in subclause (II)) that serves in that capacity with respect to 50 or more such individuals.
(ii) Within 120 days after the end of each fiscal year, the Commissioner shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the results of periodic onsite reviews conducted during the fiscal year pursuant to clause (i) and of any other reviews of representative payees conducted during such fiscal year in connection with benefits under this subchapter. Each such report shall describe in detail all problems identified in the reviews and any corrective action taken or planned to be taken to correct the problems, and shall include—
(I) the number of the reviews;
(II) the results of such reviews;
(III) the number of cases in which the representative payee was changed and why;
(IV) the number of cases involving the exercise of expedited, targeted oversight of the representative payee by the Commissioner conducted upon receipt of an allegation of misuse of funds, failure to pay a vendor, or a similar irregularity;
(V) the number of cases discovered in which there was a misuse of funds;
(VI) how any such cases of misuse of funds were dealt with by the Commissioner;
(VII) the final disposition of such cases of misuse of funds, including any criminal penalties imposed; and
(VIII) such other information as the Commissioner deems appropriate.
(H)(i) If the Commissioner of Social Security or a court of competent jurisdiction determines that a representative payee that is not a Federal, State, or local government agency has misused all or part of an individual's benefit that was paid to the representative payee under this paragraph, the representative payee shall be liable for the amount misused, and the amount (to the extent not repaid by the representative payee) shall be treated as an overpayment of benefits under this subchapter to the representative payee for all purposes of this chapter and related laws pertaining to the recovery of the overpayments. Subject to clause (ii), upon recovering all or any part of the amount, the Commissioner shall make payment of an amount equal to the recovered amount to such individual or such individual's alternative representative payee.
(ii) The total of the amount paid to such individual or such individual's alternative representative payee under clause (i) and the amount paid under subparagraph (E) may not exceed the total benefit amount misused by the representative payee with respect to such individual.
(I) For purposes of this paragraph, the term "certified community-based nonprofit social service agency" means a community-based nonprofit social service agency which is in compliance with requirements, under regulations which shall be prescribed by the Commissioner, for annual certification to the Commissioner that it is bonded in accordance with requirements specified by the Commissioner and that it is licensed in each State in which it serves as a representative payee (if licensing is available in the State) in accordance with requirements specified by the Commissioner. Any such annual certification shall include a copy of any independent audit on the agency which may have been performed since the previous certification.
(3) The Commissioner of Social Security may by regulation establish ranges of incomes within which a single amount of benefits under this subchapter shall apply.
(4) The Commissioner of Social Security—
(A) may make to any individual initially applying for benefits under this subchapter who is presumptively eligible for such benefits for the month following the date the application is filed and who is faced with financial emergency a cash advance against such benefits, including any federally-administered State supplementary payments, in an amount not exceeding the monthly amount that would be payable to an eligible individual with no other income for the first month of such presumptive eligibility, which shall be repaid through proportionate reductions in such benefits over a period of not more than 6 months; and
(B) may pay benefits under this subchapter to an individual applying for such benefits on the basis of disability or blindness for a period not exceeding 6 months prior to the determination of such individual's disability or blindness, if such individual is presumptively disabled or blind and is determined to be otherwise eligible for such benefits, and any benefits so paid prior to such determination shall in no event be considered overpayments for purposes of subsection (b) solely because such individual is determined not to be disabled or blind.
(5) Payment of the benefit of any individual who is an aged, blind, or disabled individual solely by reason of blindness (as determined under
(6) Notwithstanding any other provision of this subchapter, payment of the benefit of any individual who is an aged, blind, or disabled individual solely by reason of blindness (as determined under
(A) such individual is participating in a program consisting of the Ticket to Work and Self-Sufficiency Program under
(B) the Commissioner of Social Security determines that the completion of such program, or its continuation for a specified period of time, will increase the likelihood that such individual may (following his participation in such program) be permanently removed from the blindness and disability benefit rolls.
(7)(A) In any case where—
(i) an individual is a recipient of benefits based on disability or blindness under this subchapter,
(ii) the physical or mental impairment on the basis of which such benefits are payable is found to have ceased, not to have existed, or to no longer be disabling, and as a consequence such individual is determined not to be entitled to such benefits, and
(iii) a timely request for review or for a hearing is pending with respect to the determination that he is not so entitled,
such individual may elect (in such manner and form and within such time as the Commissioner of Social Security shall by regulations prescribe) to have the payment of such benefits continued for an additional period beginning with the first month beginning after October 9, 1984, for which (under such determination) such benefits are no longer otherwise payable, and ending with the earlier of (I) the month preceding the month in which a decision is made after such a hearing, or (II) the month preceding the month in which no such request for review or a hearing is pending.
(B)(i) If an individual elects to have the payment of his benefits continued for an additional period under subparagraph (A), and the final decision of the Commissioner of Social Security affirms the determination that he is not entitled to such benefits, any benefits paid under this subchapter pursuant to such election (for months in such additional period) shall be considered overpayments for all purposes of this subchapter, except as otherwise provided in clause (ii).
(ii) If the Commissioner of Social Security determines that the individual's appeal of his termination of benefits was made in good faith, all of the benefits paid pursuant to such individual's election under subparagraph (A) shall be subject to waiver consideration under the provisions of subsection (b)(1).
(C) The provisions of subparagraphs (A) and (B) shall apply with respect to determinations (that individuals are not entitled to benefits) which are made on or after October 9, 1984, or prior to such date but only on the basis of a timely request for review or for a hearing.
(8)(A) In any case in which an administrative law judge has determined after a hearing as provided in subsection (c) that an individual is entitled to benefits based on disability or blindness under this subchapter and the Commissioner of Social Security has not issued the Commissioner's final decision in such case within 110 days after the date of the administrative law judge's determination, such benefits shall be currently paid for the months during the period beginning with the month in which such 110-day period expires and ending with the month in which such final decision is issued.
(B) For purposes of subparagraph (A), in determining whether the 110-day period referred to in subparagraph (A) has elapsed, any period of time for which the action or inaction of such individual or such individual's representative without good cause results in the delay in the issuance of the Commissioner's final decision shall not be taken into account to the extent that such period of time exceeds 20 calendar days.
(C) Any benefits currently paid under this subchapter pursuant to this paragraph (for the months described in subparagraph (A)) shall not be considered overpayments for any purposes of this subchapter, unless payment of such benefits was fraudulently obtained.
(9) Benefits under this subchapter shall not be denied to any individual solely by reason of the refusal of the individual to accept an amount offered as compensation for a crime of which the individual was a victim.
(10)(A) If an individual is eligible for past-due monthly benefits under this subchapter in an amount that (after any withholding for reimbursement to a State for interim assistance under subsection (g) and payment of attorney fees under subsection (d)(2)(B)) equals or exceeds the product of—
(i) 3, and
(ii) the maximum monthly benefit payable under this subchapter to an eligible individual (or, if appropriate, to an eligible individual and eligible spouse),
then the payment of such past-due benefits (after any such reimbursement to a State and payment of attorney fees under subsection (d)(2)(B)) shall be made in installments as provided in subparagraph (B).
(B)(i) The payment of past-due benefits subject to this subparagraph shall be made in not to exceed 3 installments that are made at 6-month intervals.
(ii) Except as provided in clause (iii), the amount of each of the first and second installments may not exceed an amount equal to the product of clauses (i) and (ii) of subparagraph (A).
(iii) In the case of an individual who has—
(I) outstanding debt attributable to—
(aa) food,
(bb) clothing,
(cc) shelter, or
(dd) medically necessary services, supplies or equipment, or medicine; or
(II) current expenses or expenses anticipated in the near term attributable to—
(aa) medically necessary services, supplies or equipment, or medicine, or
(bb) the purchase of a home, and
such debt or expenses are not subject to reimbursement by a public assistance program, the Secretary under subchapter XVIII, a State plan approved under subchapter XIX, or any private entity legally liable to provide payment pursuant to an insurance policy, pre-paid plan, or other arrangement, the limitation specified in clause (ii) may be exceeded by an amount equal to the total of such debt and expenses.
(C) This paragraph shall not apply to any individual who, at the time of the Commissioner's determination that such individual is eligible for the payment of past-due monthly benefits under this subchapter—
(i) is afflicted with a medically determinable impairment that is expected to result in death within 12 months; or
(ii) is ineligible for benefits under this subchapter and the Commissioner determines that such individual is likely to remain ineligible for the next 12 months.
(D) For purposes of this paragraph, the term "benefits under this subchapter" includes supplementary payments pursuant to an agreement for Federal administration under
(b) Overpayments and underpayments; adjustment, recovery, or payment of amounts by Commissioner
(1)(A) Whenever the Commissioner of Social Security finds that more or less than the correct amount of benefits has been paid with respect to any individual, proper adjustment or recovery shall, subject to the succeeding provisions of this subsection, be made by appropriate adjustments in future payments to such individual or by recovery from such individual or his eligible spouse (or from the estate of either) or by payment to such individual or his eligible spouse, or, if such individual is deceased, by payment—
(i) to any surviving spouse of such individual, whether or not the individual's eligible spouse, if (within the meaning of the first sentence of
(ii) if such individual was a disabled or blind child who was living with his parent or parents at the time of his death or within the 6 months immediately preceding the month of such death, to such parent or parents.
(B) The Commissioner of Social Security (i) shall make such provision as the Commissioner finds appropriate in the case of payment of more than the correct amount of benefits with respect to an individual with a view to avoiding penalizing such individual or his eligible spouse who was without fault in connection with the overpayment, if adjustment or recovery on account of such overpayment in such case would defeat the purposes of this subchapter, or be against equity and good conscience, or (because of the small amount involved) impede efficient or effective administration of this subchapter, and (ii) shall in any event make the adjustment or recovery (in the case of payment of more than the correct amount of benefits), in the case of an individual or eligible spouse receiving monthly benefit payments under this subchapter (including supplementary payments of the type described in
(2) Notwithstanding any other provision of this section, when any payment of more than the correct amount is made to or on behalf of an individual who has died, and such payment—
(A) is made by direct deposit to a financial institution;
(B) is credited by the financial institution to a joint account of the deceased individual and another person; and
(C) such other person is the surviving spouse of the deceased individual, and was eligible for a payment under this subchapter (including any State supplementation payment paid by the Commissioner of Social Security) as an eligible spouse (or as either member of an eligible couple) for the month in which the deceased individual died,
the amount of such payment in excess of the correct amount shall be treated as a payment of more than the correct amount to such other person. If any payment of more than the correct amount is made to a representative payee on behalf of an individual after the individual's death, the representative payee shall be liable for the repayment of the overpayment, and the Commissioner of Social Security shall establish an overpayment control record under the social security account number of the representative payee.
(3)(A) When any payment of more than the correct amount is made on behalf of an individual who is a represented minor beneficiary for a month in which such individual is in foster care under the responsibility of a State and the State is the representative payee of such individual, the State shall be liable for the repayment of the overpayment, and there shall be no adjustment of payments to, or recovery by the United States from, such individual.
(B) For purposes of this paragraph, the term "represented minor beneficiary", with respect to an individual for a month, means a child (as defined for purposes of
(4) If any overpayment with respect to an individual (or an individual and his or her spouse) is attributable solely to the ownership or possession by such individual (and spouse if any) of resources having a value which exceeds the applicable dollar figure specified in paragraph (1)(B) or (2)(B) of
(5)(A) With respect to any delinquent amount, the Commissioner of Social Security may use the collection practices described in
(B) For purposes of subparagraph (A), the term "delinquent amount" means an amount—
(i) in excess of the correct amount of payment under this subchapter;
(ii) paid to a person after such person has attained 18 years of age; and
(iii) determined by the Commissioner of Social Security, under regulations, to be otherwise unrecoverable under this section after such person ceases to be a beneficiary under this subchapter.
(6) For payments for which adjustments are made by reason of a retroactive payment of benefits under subchapter II, see
(7) For provisions relating to the cross-program recovery of overpayments made under programs administered by the Commissioner of Social Security, see
(8)(A) In the case of payment of less than the correct amount of benefits to or on behalf of any individual, no payment shall be made to such individual pursuant to this subsection during any period for which such individual—
(i) is not an eligible individual or eligible spouse under
(ii) is not an eligible individual or eligible spouse under
until such person is no longer considered an ineligible individual or ineligible spouse under
(B) Nothing in subparagraph (A) shall be construed to limit the Commissioner's authority to withhold amounts, make adjustments, or recover amounts due under this subchapter, subchapter II, or subchapter VIII that would be deducted from a payment that would otherwise be payable to such individual but for such subparagraph.
(c) Hearing to determine eligibility or amount of benefits; subsequent application; time within which to request hearing; time for determinations of Commissioner pursuant to hearing; judicial review
(1)(A) The Commissioner of Social Security is directed to make findings of fact, and decisions as to the rights of any individual applying for payment under this subchapter. Any such decision by the Commissioner of Social Security which involves a determination of disability and which is in whole or in part unfavorable to such individual shall contain a statement of the case, in understandable language, setting forth a discussion of the evidence, and stating the Commissioner's determination and the reason or reasons upon which it is based. The Commissioner of Social Security shall provide reasonable notice and opportunity for a hearing to any individual who is or claims to be an eligible individual or eligible spouse and is in disagreement with any determination under this subchapter with respect to eligibility of such individual for benefits, or the amount of such individual's benefits, if such individual requests a hearing on the matter in disagreement within sixty days after notice of such determination is received, and, if a hearing is held, shall, on the basis of evidence adduced at the hearing affirm, modify, or reverse the Commissioner's findings of fact and such decision. The Commissioner of Social Security is further authorized, on the Commissioner's own motion, to hold such hearings and to conduct such investigations and other proceedings as the Commissioner may deem necessary or proper for the administration of this subchapter. In the course of any hearing, investigation, or other proceeding, the Commissioner may administer oaths and affirmations, examine witnesses, and receive evidence. Evidence may be received at any hearing before the Commissioner of Social Security even though inadmissible under the rules of evidence applicable to court procedure. The Commissioner of Social Security shall specifically take into account any physical, mental, educational, or linguistic limitation of such individual (including any lack of facility with the English language) in determining, with respect to the eligibility of such individual for benefits under this subchapter, whether such individual acted in good faith or was at fault, and in determining fraud, deception, or intent.
(B)(i) A failure to timely request review of an initial adverse determination with respect to an application for any payment under this subchapter or an adverse determination on reconsideration of such an initial determination shall not serve as a basis for denial of a subsequent application for any payment under this subchapter if the applicant demonstrates that the applicant, or any other individual referred to in subparagraph (A), failed to so request such a review acting in good faith reliance upon incorrect, incomplete, or misleading information, relating to the consequences of reapplying for payments in lieu of seeking review of an adverse determination, provided by any officer or employee of the Social Security Administration or any State agency acting under
(ii) In any notice of an adverse determination with respect to which a review may be requested under subparagraph (A), the Commissioner of Social Security shall describe in clear and specific language the effect on possible eligibility to receive payments under this subchapter of choosing to reapply in lieu of requesting review of the determination.
(2) Determination on the basis of such hearing, except to the extent that the matter in disagreement involves a disability (within the meaning of
(3) The final determination of the Commissioner of Social Security after a hearing under paragraph (1) shall be subject to judicial review as provided in
(d) Procedures applicable; prohibition on assignment of payments; representation of claimants; maximum fees; penalties for violations
(1) The provisions of
(2)(A) The provisions of
(i) by substituting, in subparagraphs (A)(ii)(I) and (D)(i) of subsection (a)(2) 1 the phrase "(as determined before any applicable reduction under
(ii) by substituting, in subsections (a)(2)(B) and (b)(1)(B)(i), the phrase "paragraph (7)(A) or (8)(A) of
(iii) by substituting, in subsection (a)(2)(C)(i), the phrase "under subchapter II" for the phrase "under subchapter XVI";
(iv) by substituting, in subsection (b)(1)(A), the phrase "pay the amount of such fee" for the phrase "certify the amount of such fee for payment" and by striking, in subsection (b)(1)(A), the phrase "or certified for payment";
(v) by substituting, in subsection (b)(1)(B)(ii), the phrase "deemed to be such amounts as determined before any applicable reduction under
(vi) by substituting, in subsection (e)(1)—
(I) "subparagraphs (B) and (C) of
(II) "subchapter XVI" for "this subchapter".
(B) Subject to subparagraph (C), if the claimant is determined to be entitled to past-due benefits under this subchapter and the person representing the claimant is an attorney, the Commissioner of Social Security shall pay out of such past-due benefits to such attorney an amount equal to the lesser of—
(i) so much of the maximum fee as does not exceed 25 percent of such past-due benefits (as determined before any applicable reduction under subsection (g) and reduced by the amount of any reduction in benefits under this subchapter or subchapter II pursuant to
(ii) the amount of past-due benefits available after any applicable reductions under subsection (g) and
(C)(i) Whenever a fee for services is required to be paid to an attorney from a claimant's past-due benefits pursuant to subparagraph (B), the Commissioner shall impose on the attorney an assessment calculated in accordance with clause (ii).
(ii)(I) The amount of an assessment under clause (i) shall be equal to the product obtained by multiplying the amount of the representative's fee that would be required to be paid by subparagraph (B) before the application of this subparagraph, by the percentage specified in subclause (II), except that the maximum amount of the assessment may not exceed $75. In the case of any calendar year beginning after the amendments made by section 302 of the Social Security Protection Act of 2003 3 take effect, the dollar amount specified in the preceding sentence (including a previously adjusted amount) shall be adjusted annually under the procedures used to adjust benefit amounts under
(II) The percentage specified in this subclause is such percentage rate as the Commissioner determines is necessary in order to achieve full recovery of the costs of determining and approving fees to attorneys from the past-due benefits of claimants, but not in excess of 6.3 percent.
(iii) The Commissioner may collect the assessment imposed on an attorney under clause (i) by offset from the amount of the fee otherwise required by subparagraph (B) to be paid to the attorney from a claimant's past-due benefits.
(iv) An attorney subject to an assessment under clause (i) may not, directly or indirectly, request or otherwise obtain reimbursement for such assessment from the claimant whose claim gave rise to the assessment.
(v) Assessments on attorneys collected under this subparagraph shall be deposited as miscellaneous receipts in the general fund of the Treasury.
(vi) The assessments authorized under this subparagraph shall be collected and available for obligation only to the extent and in the amount provided in advance in appropriations Acts. Amounts so appropriated are authorized to remain available until expended, for administrative expenses in carrying out this subchapter and related laws.
(D) The Commissioner of Social Security shall notify each claimant in writing, together with the notice to such claimant of an adverse determination, of the options for obtaining attorneys to represent individuals in presenting their cases before the Commissioner of Social Security. Such notification shall also advise the claimant of the availability to qualifying claimants of legal services organizations which provide legal services free of charge.
(e) Administrative requirements prescribed by Commissioner; criteria; reduction of benefits to individual for noncompliance with requirements; payment to homeless
(1)(A) The Commissioner of Social Security shall, subject to subparagraph (B) and subsection (j), prescribe such requirements with respect to the filing of applications, the suspension or termination of assistance, the furnishing of other data and material, and the reporting of events and changes in circumstances, as may be necessary for the effective and efficient administration of this subchapter.
(B)(i) The requirements prescribed by the Commissioner of Social Security pursuant to subparagraph (A) shall require that eligibility for benefits under this subchapter will not be determined solely on the basis of declarations by the applicant concerning eligibility factors or other relevant facts, and that relevant information will be verified from independent or collateral sources and additional information obtained as necessary in order to assure that such benefits are only provided to eligible individuals (or eligible spouses) and that the amounts of such benefits are correct. For this purpose and for purposes of federally administered supplementary payments of the type described in
(ii)(I) The Commissioner of Social Security may require each applicant for, or recipient of, benefits under this subchapter to provide authorization by the applicant or recipient (or by any other person whose income or resources are material to the determination of the eligibility of the applicant or recipient for such benefits) for the Commissioner to obtain (subject to the cost reimbursement requirements of section 1115(a) of the Right to Financial Privacy Act [
(II) Notwithstanding section 1104(a)(1) of the Right to Financial Privacy Act [
(aa) the rendering of a final adverse decision on the applicant's application for eligibility for benefits under this subchapter;
(bb) the cessation of the recipient's eligibility for benefits under this subchapter; or
(cc) the express revocation by the applicant or recipient (or such other person referred to in subclause (I)) of the authorization, in a written notification to the Commissioner.
(III)(aa) An authorization obtained by the Commissioner of Social Security pursuant to this clause shall be considered to meet the requirements of the Right to Financial Privacy Act [
(bb) The certification requirements of section 1103(b) of the Right to Financial Privacy Act [
(cc) A request by the Commissioner pursuant to an authorization provided under this clause is deemed to meet the requirements of section 1104(a)(3) of the Right to Financial Privacy Act [
(IV) The Commissioner shall inform any person who provides authorization pursuant to this clause of the duration and scope of the authorization.
(V) If an applicant for, or recipient of, benefits under this subchapter (or any such other person referred to in subclause (I)) refuses to provide, or revokes, any authorization made by the applicant or recipient for the Commissioner of Social Security to obtain from any financial institution any financial record, the Commissioner may, on that basis, determine that the applicant or recipient is ineligible for benefits under this subchapter, determine that adjustment or recovery on account of an overpayment with respect to the applicant or recipient would not defeat the purpose of this subchapter, or both.
(iii)(I) The Commissioner of Social Security may require each applicant for, or recipient of, benefits under this subchapter to provide authorization by the applicant, recipient or legal guardian (or by any other person whose income or resources are material to the determination of the eligibility of the applicant or recipient for such benefits) for the Commissioner to obtain from any payroll data provider (as defined in
(II) An authorization provided by an applicant, recipient or legal guardian (or any other person whose income or resources are material to the determination of the eligibility of the applicant or recipient) under this clause shall remain effective until the earliest of—
(aa) the rendering of a final adverse decision on the applicant's application for eligibility for benefits under this subchapter;
(bb) the cessation of the recipient's eligibility for benefits under this subchapter;
(cc) the express revocation by the applicant, or recipient (or such other person referred to in subclause (I)) of the authorization, in a written notification to the Commissioner; or
(dd) the termination of the basis upon which the Commissioner considers another person's income and resources available to the applicant or recipient.
(III) The Commissioner of Social Security is not required to furnish any authorization obtained pursuant to this clause to the payroll data provider.
(IV) The Commissioner shall inform any person who provides authorization pursuant to this clause of the duration and scope of the authorization.
(V) If an applicant for, or recipient of, benefits under this subchapter (or any such other person referred to in subclause (I)) refuses to provide, or revokes, any authorization required by subclause (I), paragraph (2)(B) and paragraph (10) shall not apply to such applicant or recipient beginning with the first day of the first month in which he or she refuses or revokes such authorization.
(C) For purposes of making determinations under
(2)(A) In the case of the failure by any individual to submit a report of events and changes in circumstances relevant to eligibility for or amount of benefits under this subchapter as required by the Commissioner of Social Security under paragraph (1), or delay by any individual in submitting a report as so required, the Commissioner of Social Security (in addition to taking any other action the Commissioner may consider appropriate under paragraph (1)) shall reduce any benefits which may subsequently become payable to such individual under this subchapter by—
(i) $25 in the case of the first such failure or delay,
(ii) $50 in the case of the second such failure or delay, and
(iii) $100 in the case of the third or a subsequent such failure or delay,
except where the individual was without fault or good cause for such failure or delay existed.
(B) For purposes of subparagraph (A), the Commissioner of Social Security shall find that good cause exists for the failure of, or delay by, an individual in submitting a report of an event or change in circumstances relevant to eligibility for or amount of benefits under this subchapter in any case where—
(i) the individual (or another person referred to in paragraph (1)(B)(iii)(I)) has provided authorization to the Commissioner to access payroll data records related to the individual; and
(ii) the event or change in circumstance is a change in the individual's employer.
(3) The Commissioner of Social Security shall provide a method of making payments under this subchapter to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address.
(4) A translation into English by a third party of a statement made in a foreign language by an applicant for or recipient of benefits under this subchapter shall not be regarded as reliable for any purpose under this subchapter unless the third party, under penalty of perjury—
(A) certifies that the translation is accurate; and
(B) discloses the nature and scope of the relationship between the third party and the applicant or recipient, as the case may be.
(5) In any case in which it is determined to the satisfaction of the Commissioner of Social Security that an individual failed as of any date to apply for benefits under this subchapter by reason of misinformation provided to such individual by any officer or employee of the Social Security Administration relating to such individual's eligibility for benefits under this subchapter, such individual shall be deemed to have applied for such benefits on the later of—
(A) the date on which such misinformation was provided to such individual, or
(B) the date on which such individual met all requirements for entitlement to such benefits (other than application therefor).
(6) In any case in which an individual visits a field office of the Social Security Administration and represents during the visit to an officer or employee of the Social Security Administration in the office that the individual's visit is occasioned by—
(A) the receipt of a notice from the Social Security Administration indicating a time limit for response by the individual, or
(B) the theft, loss, or nonreceipt of a benefit payment under this subchapter,
the Commissioner of Social Security shall ensure that the individual is granted a face-to-face interview at the office with an officer or employee of the Social Security Administration before the close of business on the day of the visit.
(7)(A)(i) The Commissioner of Social Security shall immediately redetermine the eligibility of an individual for benefits under this subchapter if there is reason to believe that fraud or similar fault was involved in the application of the individual for such benefits, unless a United States attorney, or equivalent State prosecutor, with jurisdiction over potential or actual related criminal cases, certifies, in writing, that there is a substantial risk that such action by the Commissioner of Social Security with regard to recipients in a particular investigation would jeopardize the criminal prosecution of a person involved in a suspected fraud.
(ii) When redetermining the eligibility, or making an initial determination of eligibility, of an individual for benefits under this subchapter, the Commissioner of Social Security shall disregard any evidence if there is reason to believe that fraud or similar fault was involved in the providing of such evidence.
(B) For purposes of subparagraph (A), similar fault is involved with respect to a determination if—
(i) an incorrect or incomplete statement that is material to the determination is knowingly made; or
(ii) information that is material to the determination is knowingly concealed.
(C) If, after redetermining the eligibility of an individual for benefits under this subchapter, the Commissioner of Social Security determines that there is insufficient evidence to support such eligibility, the Commissioner of Social Security may terminate such eligibility and may treat benefits paid on the basis of such insufficient evidence as overpayments.
(8)(A) The Commissioner of Social Security shall request the Immigration and Naturalization Service or the Centers for Disease Control to provide the Commissioner of Social Security with whatever medical information, identification information, and employment history either such entity has with respect to any alien who has applied for benefits under this subchapter to the extent that the information is relevant to any determination relating to eligibility for such benefits under this subchapter.
(B) Subparagraph (A) shall not be construed to prevent the Commissioner of Social Security from adjudicating the case before receiving such information.
(9) Notwithstanding any other provision of law, the Commissioner shall, at least 4 times annually and upon request of the Immigration and Naturalization Service (hereafter in this paragraph referred to as the "Service"), furnish the Service with the name and address of, and other identifying information on, any individual who the Commissioner knows is not lawfully present in the United States, and shall ensure that each agreement entered into under
(10) An individual who has authorized the Commissioner of Social Security to obtain records from a payroll data provider under paragraph (1)(B)(iii) (or on whose behalf another person described in subclause (I) of such paragraph has provided such authorization) shall not be subject to a penalty under
(f) Furnishing of information by Federal agencies
The head of any Federal agency shall provide such information as the Commissioner of Social Security needs for purposes of determining eligibility for or amount of benefits, or verifying other information with respect thereto.
(g) Reimbursement to States for interim assistance payments
(1) Notwithstanding subsection (d)(1) and subsection (b) as it relates to the payment of less than the correct amount of benefits, the Commissioner of Social Security may, upon written authorization by an individual, withhold benefits due with respect to that individual and may pay to a State (or a political subdivision thereof if agreed to by the Commissioner of Social Security and the State) from the benefits withheld an amount sufficient to reimburse the State (or political subdivision) for interim assistance furnished on behalf of the individual by the State (or political subdivision).
(2) For purposes of this subsection, the term "benefits" with respect to any individual means supplemental security income benefits under this subchapter, and any State supplementary payments under
(3) For purposes of this subsection, the term "interim assistance" with respect to any individual means assistance financed from State or local funds and furnished for meeting basic needs (A) during the period, beginning with the month following the month in which the individual filed an application for benefits (as defined in paragraph (2)), for which he was eligible for such benefits, or (B) during the period beginning with the first month for which the individual's benefits (as defined in paragraph (2)) have been terminated or suspended if the individual was subsequently found to have been eligible for such benefits.
(4) In order for a State to receive reimbursement under the provisions of paragraph (1), the State shall have in effect an agreement with the Commissioner of Social Security which shall provide—
(A) that if the Commissioner of Social Security makes payment to the State (or a political subdivision of the State as provided for under the agreement) in reimbursement for interim assistance (as defined in paragraph (3)) for any individual in an amount greater than the reimbursable amount authorized by paragraph (1), the State (or political subdivision) shall pay to the individual the balance of such payment in excess of the reimbursable amount as expeditiously as possible, but in any event within ten working days or a shorter period specified in the agreement; and
(B) that the State will comply with such other rules as the Commissioner of Social Security finds necessary to achieve efficient and effective administration of this subsection and to carry out the purposes of the program established by this subchapter, including protection of hearing rights for any individual aggrieved by action taken by the State (or political subdivision) pursuant to this subsection.
(5) The provisions of subsection (c) shall not be applicable to any disagreement concerning payment by the Commissioner of Social Security to a State pursuant to the preceding provisions of this subsection nor the amount retained by the State (or political subdivision).
(h) Payment of certain travel expenses
The Commissioner of Social Security shall pay travel expenses, either on an actual cost or commuted basis, to individuals for travel incident to medical examinations requested by the Commissioner of Social Security in connection with disability determinations under this subchapter, and to parties, their representatives, and all reasonably necessary witnesses for travel within the United States (as defined in
(i) Unnegotiated checks; notice to Commissioner; payment to States; notice to States; investigation of payees
(1) The Secretary of the Treasury shall, on a monthly basis, notify the Commissioner of Social Security of all benefit checks issued under this subchapter which include amounts representing State supplementary payments as described in paragraph (2) and which have not been presented for payment within one hundred and eighty days after the day on which they were issued.
(2) The Commissioner of Social Security shall from time to time determine the amount representing the total of the State supplementary payments made pursuant to agreements under
(3) The Commissioner of Social Security, upon notice from the Secretary of the Treasury under paragraph (1), shall notify any State having an agreement described in paragraph (2) of all such benefit checks issued under that State's agreement which were not presented for payment within one hundred and eighty days after the day on which they were issued.
(4) The Commissioner of Social Security shall, to the maximum extent feasible, investigate the whereabouts and eligibility of the individuals whose benefit checks were not presented for payment within one hundred and eighty days after the day on which they were issued.
(j) Application and review requirements for certain individuals
(1) Notwithstanding any provision of
(A) was an eligible individual (or eligible spouse) under
(B) who, after such eligibility, is ineligible for benefits under or pursuant to both such sections for a period of 12 consecutive months (or 24 consecutive months, in the case of such an individual whose ineligibility for benefits under or pursuant to both such sections is a result of being called to active duty pursuant to
may not thereafter become eligible for benefits under or pursuant to either such section until the individual has reapplied for benefits under
(2)(A) Notwithstanding any provision of
(i)(I) on the basis of the same impairment on which his or her eligibility under such
(II) has earned income (other than income excluded pursuant to
(ii)(I) on the basis of the same impairment on which his or her eligibility under such
(II) has earned income (other than income excluded pursuant to
shall, upon becoming eligible (as described in clause (i)(I) or (ii)(I)), be subject to a prompt review of the type described in
(B) If the Commissioner of Social Security determines pursuant to a review required by subparagraph (A) that the impairment upon which the eligibility of an individual is based has ceased, does not exist, or is not disabling, such individual may not thereafter become eligible for a benefit under or pursuant to
(k) Notifications to applicants and recipients
The Commissioner of Social Security shall notify an individual receiving benefits under
(1) at the time of the initial award of benefits to the individual under
(2) at the earliest time after an initial award of benefits to an individual under
(l) Special notice to blind individuals with respect to hearings and other official actions
(1) In any case where an individual who is applying for or receiving benefits under this subchapter on the basis of blindness is entitled (under subsection (c) or otherwise) to receive notice from the Commissioner of Social Security of any decision or determination made or other action taken or proposed to be taken with respect to his or her rights under this subchapter, such individual shall at his or her election be entitled either (A) to receive a supplementary notice of such decision, determination, or action, by telephone, within 5 working days after the initial notice is mailed, (B) to receive the initial notice in the form of a certified letter, or (C) to receive notification by some alternative procedure established by the Commissioner of Social Security and agreed to by the individual.
(2) The election under paragraph (1) may be made at any time; but an opportunity to make such an election shall in any event be given (A) to every individual who is an applicant for benefits under this subchapter on the basis of blindness, at the time of his or her application, and (B) to every individual who is a recipient of such benefits on the basis of blindness, at the time of each redetermination of his or her eligibility. Such an election, once made by an individual, shall apply with respect to all notices of decisions, determinations, and actions which such individual may thereafter be entitled to receive under this subchapter until such time as it is revoked or changed.
(m) Pre-release procedures for institutionalized persons
The Commissioner of Social Security shall develop a system under which an individual can apply for supplemental security income benefits under this subchapter prior to the discharge or release of the individual from a public institution.
(n) Concurrent SSI and supplemental nutrition assistance applications by institutionalized individuals
The Commissioner of Social Security and the Secretary of Agriculture shall develop a procedure under which an individual who applies for supplemental security income benefits under this subchapter shall also be permitted to apply at the same time for participation in the supplemental nutrition assistance program authorized under the Food and Nutrition Act of 2008 (
(o) Notice requirements
The Commissioner of Social Security shall take such actions as are necessary to ensure that any notice to one or more individuals issued pursuant to this subchapter by the Commissioner of Social Security or by a State agency—
(1) is written in simple and clear language, and
(2) includes the address and telephone number of the local office of the Social Security Administration which serves the recipient.
In the case of any such notice which is not generated by a local servicing office, the requirements of paragraph (2) shall be treated as satisfied if such notice includes the address of the local office of the Social Security Administration which services the recipient of the notice and a telephone number through which such office can be reached.
(p) Reinstatement of eligibility on the basis of blindness or disability
(1)(A) Eligibility for benefits under this subchapter shall be reinstated in any case where the Commissioner determines that an individual described in subparagraph (B) has filed a request for reinstatement meeting the requirements of paragraph (2)(A) during the period prescribed in subparagraph (C). Reinstatement of eligibility shall be in accordance with the terms of this subsection.
(B) An individual is described in this subparagraph if—
(i) prior to the month in which the individual files a request for reinstatement—
(I) the individual was eligible for benefits under this subchapter on the basis of blindness or disability pursuant to an application filed therefor; and
(II) the individual thereafter was ineligible for such benefits due to earned income (or earned and unearned income) for a period of 12 or more consecutive months;
(ii) the individual is blind or disabled and the physical or mental impairment that is the basis for the finding of blindness or disability is the same as (or related to) the physical or mental impairment that was the basis for the finding of blindness or disability that gave rise to the eligibility described in clause (i);
(iii) the individual's blindness or disability renders the individual unable to perform substantial gainful activity; and
(iv) the individual satisfies the nonmedical requirements for eligibility for benefits under this subchapter.
(C)(i) Except as provided in clause (ii), the period prescribed in this subparagraph with respect to an individual is 60 consecutive months beginning with the month following the most recent month for which the individual was eligible for a benefit under this subchapter (including
(ii) In the case of an individual who fails to file a reinstatement request within the period prescribed in clause (i), the Commissioner may extend the period if the Commissioner determines that the individual had good cause for the failure to so file.
(2)(A)(i) A request for reinstatement shall be filed in such form, and containing such information, as the Commissioner may prescribe.
(ii) A request for reinstatement shall include express declarations by the individual that the individual meets the requirements specified in clauses (ii) through (iv) of paragraph (1)(B).
(B) A request for reinstatement filed in accordance with subparagraph (A) may constitute an application for benefits in the case of any individual who the Commissioner determines is not eligible for reinstated benefits under this subsection.
(3) In determining whether an individual meets the requirements of paragraph (1)(B)(ii), the provisions of
(4)(A) Eligibility for benefits reinstated under this subsection shall commence with the benefit payable for the month following the month in which a request for reinstatement is filed.
(B)(i) Subject to clause (ii), the amount of the benefit payable for any month pursuant to the reinstatement of eligibility under this subsection shall be determined in accordance with the provisions of this subchapter.
(ii) The benefit under this subchapter payable for any month pursuant to a request for reinstatement filed in accordance with paragraph (2) shall be reduced by the amount of any provisional benefit paid to such individual for such month under paragraph (7).
(C) Except as otherwise provided in this subsection, eligibility for benefits under this subchapter reinstated pursuant to a request filed under paragraph (2) shall be subject to the same terms and conditions as eligibility established pursuant to an application filed therefor.
(5) Whenever an individual's eligibility for benefits under this subchapter is reinstated under this subsection, eligibility for such benefits shall be reinstated with respect to the individual's spouse if such spouse was previously an eligible spouse of the individual under this subchapter and the Commissioner determines that such spouse satisfies all the requirements for eligibility for such benefits except requirements related to the filing of an application. The provisions of paragraph (4) shall apply to the reinstated eligibility of the spouse to the same extent that they apply to the reinstated eligibility of such individual.
(6) An individual to whom benefits are payable under this subchapter pursuant to a reinstatement of eligibility under this subsection for twenty-four months (whether or not consecutive) shall, with respect to benefits so payable after such twenty-fourth month, be deemed for purposes of paragraph (1)(B)(i)(I) to be eligible for such benefits on the basis of an application filed therefor.
(7)(A) An individual described in paragraph (1)(B) who files a request for reinstatement in accordance with the provisions of paragraph (2)(A) shall be eligible for provisional benefits payable in accordance with this paragraph, unless the Commissioner determines that the individual does not meet the requirements of paragraph (1)(B)(i) or that the individual's declaration under paragraph (2)(A)(ii) is false. Any such determination by the Commissioner shall be final and not subject to review under paragraph (1) or (3) of subsection (c).
(B)(i) Except as otherwise provided in clause (ii), the amount of a provisional benefit for a month shall equal the amount of the monthly benefit that would be payable to an eligible individual under this subchapter with the same kind and amount of income.
(ii) If the individual has a spouse who was previously an eligible spouse of the individual under this subchapter and the Commissioner determines that such spouse satisfies all the requirements of
(C)(i) Provisional benefits shall begin with the month following the month in which a request for reinstatement is filed in accordance with paragraph (2)(A).
(ii) Provisional benefits shall end with the earliest of—
(I) the month in which the Commissioner makes a determination regarding the individual's eligibility for reinstated benefits;
(II) the fifth month following the month for which provisional benefits are first payable under clause (i); or
(III) the month in which the Commissioner determines that the individual does not meet the requirements of paragraph (1)(B)(i) or that the individual's declaration made in accordance with paragraph (2)(A)(ii) is false.
(D) In any case in which the Commissioner determines that an individual is not eligible for reinstated benefits, any provisional benefits paid to the individual under this paragraph shall not be subject to recovery as an overpayment unless the Commissioner determines that the individual knew or should have known that the individual did not meet the requirements of paragraph (1)(B).
(8) For purposes of this subsection other than paragraph (7), the term "benefits under this subchapter" includes State supplementary payments made pursuant to an agreement under
(Aug. 14, 1935, ch. 531, title XVI, §1631, as added
Editorial Notes
References in Text
The Internal Revenue Code of 1986, referred to in subsecs. (a)(2)(B)(xiv) and (e)(1)(B)(i), is classified generally to Title 26, Internal Revenue Code.
Section 212 of
Section 302 of the Social Security Protection Act of 2003, referred to in subsec. (d)(2)(C)(ii)(I), probably means section 302 of the Social Security Protection Act of 2004,
The Right to Financial Privacy Act, referred to in subsec. (e)(1)(B)(ii)(III)(aa), probably means the Right to Financial Privacy Act of 1978, title XI of
The Food and Nutrition Act of 2008, referred to in subsec. (n), is
Codification
Prior Provisions
A prior section 1383, act Aug. 14, 1935, ch. 531, title XVI, §1603, as added July 25, 1962,
Amendments
2018—Subsec. (a)(2)(B)(ii)(VII).
Subsec. (a)(2)(B)(iii)(VI).
Subsec. (a)(2)(B)(iii)(VII).
Subsec. (a)(2)(B)(xv) to (xvii).
Subsec. (a)(2)(C)(iv) to (vi).
Subsec. (b)(3) to (8).
2015—Subsec. (b)(1)(B).
Subsec. (e)(1)(B)(ii)(V).
Subsec. (e)(1)(B)(iii).
Subsec. (e)(2)(A).
Subsec. (e)(2)(B).
Subsec. (e)(2)(C).
Subsec. (e)(10).
2014—Subsec. (n).
2010—Subsec. (d)(2)(A)(vi).
2009—Subsec. (b)(7).
2008—Subsec. (n).
2006—Subsec. (a)(10)(A)(i).
Subsec. (j)(1)(B).
2004—Subsec. (a)(2)(A)(iv).
Subsec. (a)(2)(B)(ii)(IV) to (VI).
Subsec. (a)(2)(B)(iii)(II).
Subsec. (a)(2)(B)(iii)(IV), (V).
Subsec. (a)(2)(B)(vii)(I).
Subsec. (a)(2)(B)(xiv).
Subsec. (a)(2)(C)(v).
Subsec. (a)(2)(D)(i).
Subsec. (a)(2)(D)(ii).
"(I) is bonded or licensed in each State in which the agency serves as a representative payee; and
"(II) in accordance",
redesignated items (aa) and (bb) as subclauses (I) and (II), respectively, realigned margins, and substituted "subclause (II)" for "subclause (II)(bb)" in concluding provisions.
Subsec. (a)(2)(E).
Subsec. (a)(2)(F)(i)(II).
Subsec. (a)(2)(G).
Subsec. (a)(2)(G)(i)(II).
Subsec. (a)(2)(H).
Subsec. (a)(2)(I).
Subsec. (a)(10)(A).
Subsec. (b)(1)(B).
Subsec. (b)(6).
Subsec. (d)(2)(A).
Subsec. (d)(2)(A)(i).
Subsec. (d)(2)(A)(ii) to (v).
Subsec. (d)(2)(B) to (D).
1999—Subsec. (a)(2)(A)(iii).
Subsec. (a)(2)(B)(ii)(I).
Subsec. (a)(2)(B)(ii)(III).
Subsec. (a)(2)(B)(ii)(IV).
Subsec. (a)(2)(B)(iii)(II).
Subsec. (a)(2)(D)(ii)(II)(aa).
Subsec. (a)(6)(A).
Subsec. (b)(1)(B)(ii).
Subsec. (b)(2).
Subsec. (b)(4) to (6).
Subsec. (e)(1)(B).
Subsec. (j)(1).
Subsec. (j)(2)(A)(i)(I).
Subsec. (p).
1998—Subsec. (b)(5).
1997—Subsec. (a)(2)(F)(ii)(III)(bb).
Subsec. (a)(2)(F)(iii).
"(I) past-due benefits payable to the eligible individual in an amount less than that specified in clause (i)(II), and
"(II) any other funds representing an underpayment under this subchapter to such individual, provided that the amount of such underpayment is equal to or exceeds the maximum monthly benefit payable under this subchapter to an eligible individual."
Subsec. (e)(9).
1996—Subsec. (a)(1).
Subsec. (a)(2)(A)(ii)(II).
Subsec. (a)(2)(B)(vii).
Subsec. (a)(2)(B)(ix)(II).
Subsec. (a)(2)(D)(i)(II).
Subsec. (a)(2)(F) to (H).
Subsec. (a)(4)(A).
Subsec. (a)(10).
Subsec. (e)(6) to (8).
Subsec. (e)(9).
Subsec. (g)(3).
1994—Subsec. (a)(2).
Subsec. (a)(2)(A)(ii).
Subsec. (a)(2)(A)(iii).
Subsec. (a)(2)(B)(i)(I), (ii), (iv) to (vi).
Subsec. (a)(2)(B)(vii).
Subsec. (a)(2)(B)(viii).
Subsec. (a)(2)(B)(ix).
Subsec. (a)(2)(B)(x) to (xii).
Subsec. (a)(2)(B)(xiii).
Subsec. (a)(2)(C).
Subsec. (a)(2)(C)(i).
Subsec. (a)(2)(C)(ii).
Subsec. (a)(2)(C)(iii).
Subsec. (a)(2)(C)(iv).
Subsec. (a)(2)(C)(v).
Subsec. (a)(2)(D)(i).
Subsec. (a)(2)(D)(i)(II).
Subsec. (a)(2)(D)(ii).
Subsec. (a)(2)(D)(iv).
Subsec. (a)(2)(D)(v).
Subsec. (a)(2)(E).
Subsec. (a)(2)(F), (G).
Subsec. (a)(3), (4), (6) to (8).
Subsec. (b).
Subsec. (b)(3) to (5).
Subsec. (c)(1)(A).
Subsec. (c)(1)(B).
Subsec. (c)(1)(B)(ii).
Subsec. (c)(3).
Subsec. (d)(2)(A)(i).
Subsec. (d)(2)(B).
Subsec. (e)(1).
Subsec. (e)(1)(C).
Subsec. (e)(2), (3).
Subsec. (e)(4).
Subsec. (e)(5).
Subsec. (e)(6).
Subsec. (e)(7).
Subsecs. (f) to (m).
Subsec. (n).
Subsec. (o).
1990—Subsec. (a)(2)(A).
Subsec. (a)(2)(B).
Subsec. (a)(2)(C)(i).
Subsec. (a)(2)(C)(ii) to (iv).
Subsec. (a)(2)(C)(v).
Subsec. (a)(2)(D).
Subsec. (a)(2)(E).
Subsec. (a)(2)(F).
Subsec. (a)(4)(B).
Subsec. (a)(6)(A).
Subsec. (a)(6)(B).
Subsec. (a)(9).
Subsec. (c)(1).
Subsec. (d)(2)(A).
Subsec. (h).
Subsec. (j)(2)(A).
Subsec. (m).
Subsec. (n).
1989—Subsec. (c)(1).
Subsec. (d)(2).
Subsec. (e)(5).
Subsec. (e)(6).
1988—Subsec. (a)(8).
1987—Subsec. (a)(4)(A).
Subsec. (a)(6).
Subsec. (g)(2).
Subsec. (g)(3).
Subsec. (j).
Subsec. (l).
Subsec. (m).
1986—Subsec. (b)(1).
Subsec. (b)(2).
Subsec. (b)(3).
Subsec. (b)(4), (5).
Subsec. (e)(1)(A).
Subsec. (e)(1)(B).
Subsec. (e)(3).
Subsec. (g).
Subsec. (j).
Subsec. (j)(2)(A).
Subsec. (k).
1984—Subsec. (a)(2).
Subsec. (a)(7).
Subsec. (b)(1).
Subsec. (b)(2).
Subsec. (b)(3), (4).
Subsec. (d)(1).
Subsec. (e)(1)(B).
1982—Subsec. (i)(2).
1981—Subsec. (i).
1980—Subsec. (a)(6).
Subsec. (b).
Subsec. (c)(1).
Subsec. (h).
1976—Subsec. (a)(4)(B).
Subsec. (c)(1).
Subsec. (c)(2).
Subsec. (c)(3).
Subsec. (d)(2), (3).
Subsec. (g).
1974—Subsec. (g).
1973—Subsec. (a)(4)(B).
Statutory Notes and Related Subsidiaries
Effective Date of 2018 Amendment
Amendment by section 202(c) of
Amendment by section 203(c) of
Effective Date of 2015 Amendment
Amendment by section 824(b)(2), (c)(2) of
Amendment by section 834(b) of
Effective Date of 2010 Amendment
Amendment by section 3(b)(1) of
Effective Date of 2009 Amendment
Amendment by
Effective Date of 2008 Amendment
Amendment of this section and repeal of
Amendment by section 4002(b)(1)(A), (B), (2)(V) of
Effective Date of 2006 Amendment
Effective and Termination Dates of 2004 Amendment
Amendment by section 101(c)(1), (3) of
Amendment by section 102(a)(2) of
Amendment by section 103(c) of
Amendment by section 104(b) of
Amendment by section 105(c) of
Amendment by section 106(c) of
Amendment by section 210(b)(4) of
"The amendments made by this section [amending this section] shall apply with respect to fees for representation of claimants which are first required to be paid under section 1631(d)(2) of the Social Security Act [
Effective Date of 1999 Amendments
Amendment by section 101(b)(2)(C) of
Amendment by section 112(b) of
Amendment by section 201(b) of
Amendment by section 203(a) of
Effective Date of 1998 Amendment
Amendment by
Effective Date of 1997 Amendment
Amendment by section 5522(b) of
Amendment by section 5564 of
Effective Date of 1996 Amendment
Amendment by section 204(b), (c)(2) of
Amendment by section 213(a) of
"(1)
"(2)
Amendment by
Effective Date of 1994 Amendment
Amendment by section 264(b) and (e)–(g) of
Amendment by section 107(a)(4) of
Amendment by section 206(a)(2) of
Amendment by section 206(d)(2) of
Amendment by section 321(f)(2)(B), (3)(A) of
Effective Date of 1990 Amendment
Amendment by section 5031(c) of
Amendment by section 5105(a)(1)(B), (2)(A)(ii) of
Amendment by section 5105(d)(1)(B) of
Amendment by section 5106(a)(2), (c) of
Amendment by section 5107(a)(2) of
Amendment by section 5109(a)(2) of
Amendment by section 5113(b) of
Effective Date of 1989 Amendment
Amendment by section 10303(b) of
Amendment by section 10305(e) of
Amendment by section 10307(a)(2) of
Amendment by section 10307(b)(2) of
Effective Date of 1988 Amendment
Amendment by
Effective Date of 1987 Amendment
Effective Date of 1986 Amendment
Amendment by sections 4(c)(1), (d)(3)(B) and 5 of
Amendment by
Effective Date of 1984 Amendment
Amendment by section 16(b) of
Amendment by sections 2612(a) and 2613 of
Amendment by section 2651(j) of
Amendment by section 2663(g)(11), (12) of
Effective Date of 1982 Amendment
Effective Date of 1981 Amendment
Effective Date of 1980 Amendment
Amendment by section 301(b) of
Amendment by section 305(b) of
Amendment by section 501(c) of
Effective Date of 1976 Amendment
Amendment by sections 1 and 2 of
Effective Date of 1973 Amendment
Amendment by
Effective Date
Regulations
Abolition of Immigration and Naturalization Service and Transfer of Functions
For abolition of Immigration and Naturalization Service, transfer of functions, and treatment of related references, see note set out under
Payment of Travel Expenses
Similar provisions were contained in the following prior appropriation acts:
Deposit of Overpayments in General Fund of Treasury
Opportunity for Individuals Receiving Benefits To Make Election for Type of Notice of Hearing or Other Official Action
Study of Desirability and Feasibility of Special Notices of Hearings and Other Actions to Other Individuals Unable To Read
Demonstration Program To Assist Homeless Individuals
"(a)
"(b)
"(1) the creation of cooperative approaches between the Social Security Administration, State and local governments, shelters for the homeless, and other providers of services to the homeless;
"(2) the establishment, where appropriate, of multi-agency SSI Outreach Teams (as described in subsection (c)), to facilitate communication between the agencies and staff involved in taking and processing claims for SSI and other benefits by the homeless who use shelters;
"(3) special efforts to identify homeless individuals who are potentially eligible for SSI or other benefits under the Social Security Act [this chapter];
"(4) the provision of special assistance to the homeless in applying for benefits, including assistance in obtaining and developing evidence of disability and supporting documentation for nondisability-related eligibility requirements;
"(5) the provision of special training and assistance to public and private agency staff, including shelter employees, on disability eligibility procedures and evidentiary requirements;
"(6) the provision of ongoing assistance to formerly homeless individuals to ensure their responding to information requests related to periodic redeterminations of eligibility for SSI and other benefits;
"(7) the provision of assistance in ensuring appropriate use of benefit funds for the purpose of enabling homeless individuals to obtain permanent housing, nutrition, and physical and mental health care, including the use, where appropriate, of the disabled individual's representative payee for case management services; and
"(8) such other procedures and services as the Secretary may approve.
"(c)
"(A) The membership of the Team shall include a social services case worker (or case workers, if necessary); a consultative medical examiner who is qualified to provide consultative examinations for the Disability Determination Service of the State; a disability examiner, from the State Disability Determination Service; and a claims representative from an office of the Social Security Administration.
"(B) The Team shall have designated members responsible for—
"(i) identification of homeless individuals who are potentially eligible for SSI or other benefits under the Social Security Act [this chapter];
"(ii) ensuring that such individuals understand their rights under the programs;
"(iii) assisting such individuals in applying for benefits, including assistance in obtaining and developing evidence and supporting documentation relating to disability- and nondisability-related eligibility requirements;
"(iv) arranging transportation and accompanying applicants to necessary examinations, if needed; and
"(v) providing for the tracking and monitoring of all claims for benefits by individuals under the project.
"(2) If the Secretary determines that an application by a State for an SSI Outreach Team Project under this section which proposes a membership and functions for such Team different from those prescribed in paragraph (1) but which is expected to be as effective, the Secretary may waive the requirements of such paragraph.
[(d) Repealed.
"(e)
"(A) the sum of $1,250,000 for the fiscal year 1988;
"(B) the sum of $2,500,000 for the fiscal year 1989; and
"(C) such sums as may be necessary for each fiscal year thereafter."
Notification of Adjustment of Benefits by Secretary
Payment of Costs of Rehabilitation Services
Amendment to
Hearing Examiners Appointed Prior to January 2, 1976
Presumptive Disability Benefits; Time Extension
Application to Northern Mariana Islands
For applicability of this section to the Northern Mariana Islands, see section 502(a)(1) of the Covenant to Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America and Proc. No. 4534, Oct. 24, 1977, 42 F.R. 6593, set out as notes under
Puerto Rico, Guam, and Virgin Islands
As enacted by
§1383. Payments to States; quarterly expenditures to exceed average of total expenditures for each quarter of fiscal year ending June 30, 1965
(a) From the sums appropriated therefor, the Commissioner of Social Security shall pay to each State which has a plan approved under this subchapter, for each quarter, beginning with the quarter commencing October 1, 1962—
(1) Repealed.
(2) in the case of Puerto Rico, the Virgin Islands, and Guam, an amount equal to—
(A) one-half of the total of the sums expended during such quarter as aid to the aged, blind, or disabled under the State plan, not counting so much of any expenditure with respect to any month as exceeds $37.50 multiplied by the total number of recipients of aid to the aged, blind, or disabled for such month; plus
(B) one-half of the amount by which such expenditures exceed the maximum which may be counted under clause (A), not counting so much of any expenditure with respect to any month as exceeds the product of $45 multiplied by the total number of such recipients of aid to the aged, blind, or disabled for such month; and
(3) Repealed.
(4) in the case of any State, an amount equal to 50 percent of the total amounts expended during such quarter as found necessary by the Commissioner of Social Security for the proper and efficient administration of the State plan.
(b)(1) Prior to the beginning of each quarter, the Commissioner of Social Security shall estimate the amount to which a State will be entitled under subsection (a) of this section for such quarter, such estimates to be based on (A) a report filed by the State containing its estimate of the total sum to be expended in such quarter in accordance with the provisions of such subsection, and stating the amount appropriated or made available by the State and its political subdivisions for such expenditures in such quarter, and if such amount is less than the State's proportionate share of the total sum of such estimated expenditures, the source or sources from which the difference is expected to be derived, and (B) such other investigation as the Commissioner of Social Security may find necessary.
(2) The Commissioner of Social Security shall then pay, in such installments as the Commissioner may determine, to the State the amount so estimated, reduced or increased to the extent of any overpayment or underpayment which the Commissioner of Social Security determines was made under this section to such State for any prior quarter and with respect to which adjustment has not already been made under this subsection.
(3) The pro rata share to which the United States is equitably entitled, as determined by the Commissioner of Social Security, of the net amount recovered during any quarter by the State or any political subdivision thereof with respect to aid or assistance furnished under the State plan, but excluding any amount of such aid or assistance recovered from the estate of a deceased recipient which is not in excess of the amount expended by the State or any political subdivision thereof for the funeral expenses of the deceased, shall be considered an overpayment to be adjusted under this subsection.
(4) Upon the making of any estimate by the Commissioner of Social Security under this subsection, any appropriations available for payments under this section shall be deemed obligated.
(Aug. 14, 1935, ch. 531, title XVI, §1603, as added
[Amendment by section 107(a)(4) of
[Amendment by
[Amendment by
Reimbursement for Erroneous State Supplementary Payments; Authorization of Appropriations
"(a) Notwithstanding any other provision of law, the Secretary of Health, Education, and Welfare [now Health and Human Services] is authorized and directed to pay to each State an amount equal to the amount expended by such State for erroneous supplementary payments to aged, blind, or disabled individuals whenever, and to the extent to which, the Secretary through an audit by the Department of Health, Education, and Welfare [now Health and Human Services] which has been reviewed and concurred in by the Inspector General of such department determines that—
"(1) such amount was paid by such State as a supplementary payment during the calendar year 1974 pursuant to an agreement between the State and the Secretary required by section 212 of the Act entitled 'An Act to extend the Renegotiation Act of 1951 for one year, and for other purposes', approved July 9, 1973, [set out as a note under
"(2) the erroneous payments were the result of good faith reliance by such State upon erroneous or incomplete information supplied by the Department of Health, Education, and Welfare [now Health and Human Services], through the State data exchange, or good faith reliance upon incorrect supplemental security income benefit payments made by such department, and
"(3) recovery of the erroneous payments by such State would be impossible or unreasonable.
"(b) There are authorized to be appropriated such sums as are necessary to carry out the provisions of this section."
1 So in original. Probably should be followed by a comma.
2 So in original. Closing parenthesis after "title" probably should not appear.
3 See References in Text note below.
§1383a. Penalties for fraud
(a) In general
Whoever—
(1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for any benefit under this subchapter,
(2) at any time knowingly and willfully makes or causes to be made any false statement or representation of a material fact for use in determining rights to any such benefit,
(3) having knowledge of the occurrence of any event affecting (A) his initial or continued right to any such benefit, or (B) the initial or continued right to any such benefit of any other individual in whose behalf he has applied for or is receiving such benefit, conceals or fails to disclose such event with an intent fraudulently to secure such benefit either in a greater amount or quantity than is due or when no such benefit is authorized,
(4) having made application to receive any such benefit for the use and benefit of another and having received it, knowingly and willfully converts such benefit or any part thereof to a use other than for the use and benefit of such other person, or
(5) conspires to commit any offense described in any of paragraphs (1) through (3),
shall be fined under title 18, imprisoned not more than 5 years, or both, except that in the case of a person who receives a fee or other income for services performed in connection with any determination with respect to benefits under this subchapter (including a claimant representative, translator, or current or former employee of the Social Security Administration), or who is a physician or other health care provider who submits, or causes the submission of, medical or other evidence in connection with any such determination, such person shall be guilty of a felony and upon conviction thereof shall be fined under title 18, or imprisoned for not more than ten years, or both.
(b) Restitution
(1) Any Federal court, when sentencing a defendant convicted of an offense under subsection (a), may order, in addition to or in lieu of any other penalty authorized by law, that the defendant make restitution to the Commissioner of Social Security, in any case in which such offense results in—
(A) the Commissioner of Social Security making a benefit payment that should not have been made, or
(B) an individual suffering a financial loss due to the defendant's violation of subsection (a) in his or her capacity as the individual's representative payee appointed pursuant to
(2)
(3) If the court does not order restitution, or orders only partial restitution, under this subsection, the court shall state on the record the reasons therefor.
(4)(A) Except as provided in subparagraph (B), funds paid to the Commissioner of Social Security as restitution pursuant to a court order shall be deposited as miscellaneous receipts in the general fund of the Treasury.
(B) In the case of funds paid to the Commissioner of Social Security pursuant to paragraph (1)(B), the Commissioner of Social Security shall certify for payment to the individual described in such paragraph an amount equal to the lesser of the amount of the funds so paid or the individual's outstanding financial loss as described in such paragraph, except that such amount may be reduced by any overpayment of benefits owed under this subchapter, subchapter II, or subchapter VIII by the individual.
(c) Prohibition on certification as representative payee
Any person or entity convicted of a violation of subsection (a) of this section or of
(Aug. 14, 1935, ch. 531, title XVI, §1632, as added
Editorial Notes
Amendments
2015—Subsec. (a).
Subsec. (a)(5).
2004—Subsec. (b).
Subsec. (c).
1994—Subsec. (a).
Subsec. (b).
"(b)(1) Any person or other entity who is convicted of a violation of any of the provisions of paragraphs (1) through (4) of subsection (a) of this section, if such violation is committed by such person or entity in his role as, or in applying to become, a payee under
"(A) upon his first such conviction, shall be guilty of a misdemeanor and shall be fined not more than $5,000 or imprisoned for not more than one year, or both; and
"(B) upon his second or any subsequent such conviction, shall be guilty of a felony and shall be fined not more than $25,000 or imprisoned for not more than five years, or both.
"(2) In any case in which the court determines that a violation described in paragraph (1) includes a willful misuse of funds by such person or entity, the court may also require that full or partial restitution of such funds be made to the individual for whom such person or entity was the certified payee.
"(3) Any person or entity convicted of a felony under this section or under
1984—
Statutory Notes and Related Subsidiaries
Effective Date of 2004 Amendment
Amendment by
Effective Date of 1994 Amendment
Effective Date of 1984 Amendment
Amendment by
Effective Date
Application to Northern Mariana Islands
For applicability of this section to the Northern Mariana Islands, see section 502(a)(1) of the Covenant to Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America and Proc. No. 4534, Oct. 24, 1977, 42 F.R. 6593, set out as notes under
Puerto Rico, Guam, and Virgin Islands
Enactment of provisions of
§1383b. Administration
(a) Authority of Commissioner
Subject to subsection (b), the Commissioner of Social Security may make such administrative and other arrangements (including arrangements for the determination of blindness and disability under section 1382c(a)(2) and (3) of this title in the same manner and subject to the same conditions as provided with respect to disability determinations under
(b) Examination to determine blindness
In determining, for purposes of this subchapter, whether an individual is blind, there shall be an examination of such individual by a physician skilled in the diseases of the eye or by an optometrist, whichever the individual may select.
(c) Notification of review
(1) In any case in which the Commissioner of Social Security initiates a review under this subchapter, similar to the continuing disability reviews authorized for purposes of subchapter II under
(2) For suspension of continuing disability reviews and other reviews under this subchapter similar to reviews under
(d) Regulations regarding completion of plans for achieving self-support
The Commissioner of Social Security shall establish by regulation criteria for time limits and other criteria related to individuals' plans for achieving self-support, that take into account—
(1) the length of time that the individual will need to achieve the individual's employment goal (within such reasonable period as the Commissioner of Social Security may establish); and
(2) other factors determined by the Commissioner of Social Security to be appropriate.
(e) Review of State agency blindness and disability determinations
(1) The Commissioner of Social Security shall review determinations, made by State agencies pursuant to subsection (a) in connection with applications for benefits under this subchapter on the basis of blindness or disability, that individuals who have attained 18 years of age are blind or disabled as of a specified onset date. The Commissioner of Social Security shall review such a determination before any action is taken to implement the determination.
(2)(A) In carrying out paragraph (1), the Commissioner of Social Security shall review—
(i) at least 20 percent of all determinations referred to in paragraph (1) that are made in fiscal year 2006;
(ii) at least 40 percent of all such determinations that are made in fiscal year 2007; and
(iii) at least 50 percent of all such determinations that are made in fiscal year 2008 or thereafter.
(B) In carrying out subparagraph (A), the Commissioner of Social Security shall, to the extent feasible, select for review the determinations which the Commissioner of Social Security identifies as being the most likely to be incorrect.
(Aug. 14, 1935, ch. 531, title XVI, §1633, as added
Editorial Notes
Amendments
2006—Subsec. (e).
1999—Subsec. (c).
1994—Subsec. (a).
Subsec. (c).
Subsec. (d).
1984—Subsec. (c).
1973—Subsec. (a).
Subsec. (b).
Statutory Notes and Related Subsidiaries
Effective Date of 2006 Amendment
Amendment by
Effective Date of 1999 Amendment
Amendment by
Effective Date of 1994 Amendment
Amendment by section 107(a)(4) of
Effective Date
Institution of Notification System
For provisions requiring the Secretary to institute the system of notification required by subsec. (c) of this section as soon as practicable after Oct. 9, 1984, see section 6(c) of
Federal Program of Supplemental Security Income; Preference for Present State and Local Employees
Application to Northern Mariana Islands
For applicability of this section to the Northern Mariana Islands, see section 502(a)(1) of the Covenant to Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America and Proc. No. 4534, Oct. 24, 1977, 42 F.R. 6593, set out as notes under
Puerto Rico, Guam, and Virgin Islands
Enactment of provisions of
§1383c. Eligibility for medical assistance of aged, blind, or disabled individuals under State's medical assistance plan
(a) Determination by Commissioner pursuant to agreement between Commissioner and State; costs
The Commissioner of Social Security may enter into an agreement with any State which wishes to do so under which the Commissioner will determine eligibility for medical assistance in the case of aged, blind, or disabled individuals under such State's plan approved under subchapter XIX. Any such agreement shall provide for payments by the State, for use by the Commissioner of Social Security in carrying out the agreement, of an amount equal to one-half of the cost of carrying out the agreement, but in computing such cost with respect to individuals eligible for benefits under this subchapter, the Commissioner of Social Security shall include only those costs which are additional to the costs incurred in carrying out this subchapter.
(b) Preservation of benefit status for certain disabled widows and widowers
(1) An eligible disabled widow or widower (described in paragraph (2)) who is entitled to a widow's or widower's insurance benefit based on a disability for any month under section 402(e) or (f) of this title but is not eligible for benefits under this subchapter in that month, and who applies for the protection of this subsection under paragraph (3), shall be deemed for purposes of subchapter XIX to be an individual with respect to whom benefits under this subchapter are paid in that month if he or she—
(A) has been continuously entitled to such widow's or widower's insurance benefits from the first month for which the increase described in paragraph (2)(C) was reflected in such benefits through the month involved, and
(B) would be eligible for benefits under this subchapter in the month involved if the amount of the increase described in paragraph (2)(C) in his or her widow's or widower's insurance benefits, and any subsequent cost-of-living adjustments in such benefits under
(2) For purposes of paragraph (1), the term "eligible disabled widow or widower" means an individual who—
(A) was entitled to a monthly insurance benefit under subchapter II for December 1983,
(B) was entitled to a widow's or widower's insurance benefit based on a disability under section 402(e) or (f) of this title for January 1984 and with respect to whom a benefit under this subchapter was paid in that month, and
(C) because of the increase in the amount of his or her widow's or widower's insurance benefits which resulted from the amendments made by section 134 of the Social Security Amendments of 1983 (
(3) This subsection shall only apply to an individual who files a written application for protection under this subsection, in such manner and form as the Commissioner of Social Security may prescribe, no later than July 1, 1988.
(4) For purposes of this subsection, the term "benefits under this subchapter" includes payments of the type described in
(c) Loss of benefits upon entitlement to child's insurance benefits based on disability
If any individual who has attained the age of 18 and is receiving benefits under this subchapter on the basis of blindness or a disability which began before he or she attained the age of 22—
(1) becomes entitled, on or after the effective date of this subsection, to child's insurance benefits which are payable under
(2) ceases to be eligible for benefits under this subchapter because of such child's insurance benefits or because of the increase in such child's insurance benefits,
such individual shall be treated for purposes of subchapter XIX as receiving benefits under this subchapter so long as he or she would be eligible for benefits under this subchapter in the absence of such child's insurance benefits or such increase.
(d) Retention of medicaid when SSI benefits are lost upon entitlement to early widow's or widower's insurance benefits
(1) This subsection applies with respect to any person who—
(A) applies for and obtains benefits under subsection (e) or (f) of
(B) is determined to be ineligible (by reason of the receipt of such benefits under
(2) For purposes of subchapter XIX, each person with respect to whom this subsection applies—
(A) shall be deemed to be a recipient of supplemental security income benefits under this subchapter if such person received such a benefit for the month before the month in which such person began to receive a benefit described in paragraph (1)(A), and
(B) shall be deemed to be a recipient of State supplementary payments of the type referred to in
for so long as such person (i) would be eligible for such supplemental security income benefits, or such State supplementary payments (or payments of the type described in section 212(a) of
(Aug. 14, 1935, ch. 531, title XVI, §1634, as added
Editorial Notes
References in Text
Section 134 of the Social Security Amendments of 1983 (
Section 212(a) of
The effective date of this subsection, referred to in subsec. (c)(1), is July 1, 1987, except as otherwise provided. See section 10(b) of
Amendments
1996—Subsec. (e).
1994—Subsecs. (a), (b)(3).
Subsec. (e).
1990—Subsec. (d).
1987—Subsec. (b)(3).
Subsec. (d).
1986—Subsec. (a).
Subsec. (b).
Subsec. (c).
Statutory Notes and Related Subsidiaries
Effective Date of 1996 Amendment
Amendment by
Effective Date of 1994 Amendment
Amendment by section 107(a)(4) of
Amendment by section 201(b)(3)(D) of
Effective Date of 1990 Amendment
Amendment by
Effective Date of 1987 Amendment
Effective Date of 1986 Amendment
Amendment by
Effective Date
Notice of Possible Eligibility for Medicaid Assistance
State Determinations
Identification of Potential Beneficiaries Under Subsection (b) of This Section
"(1) As soon as possible after the date of the enactment of this Act [Apr. 7, 1986], the Secretary of Health and Human Services shall provide each State with the names of all individuals receiving widow's or widower's insurance benefits under subsection (e) or (f) of section 202 of the Social Security Act [section 402(e) or (f) of this title] based on a disability who might qualify for medical assistance under the plan of that State approved under title XIX of such Act [subchapter XIX of this chapter] by reason of the application of section 1634(b) of the Social Security Act [subsec. (b) of this section].
"(2) Each State shall—
"(A) using the information so provided and any other information it may have, promptly notify all individuals who may qualify for medical assistance under its plan by reason of such section 1634(b) of their right to make application for such assistance,
"(B) solicit their applications for such assistance, and
"(C) make the necessary determination of such individuals' eligibility for such assistance under such section and under such title XIX."
Application to Northern Mariana Islands
For applicability of this section to the Northern Mariana Islands, see section 502(a)(1) of the Covenant to Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America and Proc. No. 4534, Oct. 24, 1977, 42 F.R. 6593, set out as notes under
Puerto Rico, Guam, and Virgin Islands
Enactment of provisions of
§1383d. Outreach program for children
(a) Establishment
The Commissioner of Social Security shall establish and conduct an ongoing program of outreach to children who are potentially eligible for benefits under this subchapter by reason of disability or blindness.
(b) Requirements
Under this program, the Commissioner of Social Security shall—
(1) aim outreach efforts at populations for whom such efforts would be most effective; and
(2) work in cooperation with other Federal, State, and private agencies, and nonprofit organizations, which serve blind or disabled individuals and have knowledge of potential recipients of supplemental security income benefits, and with agencies and organizations (including school systems and public and private social service agencies) which focus on the needs of children.
(Aug. 14, 1935, ch. 531, title XVI, §1635, as added
Editorial Notes
Amendments
1994—Subsecs. (a), (b).
Statutory Notes and Related Subsidiaries
Effective Date of 1994 Amendment
Amendment by
Effective Date
Application to Northern Mariana Islands
For applicability of this section to the Northern Mariana Islands, see section 502(a)(1) of the Covenant to Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America and Proc. No. 4534, Oct. 24, 1977, 42 F.R. 6593, set out as notes under
§1383e. Treatment referrals for individuals with alcoholism or drug addiction condition
In the case of any individual whose benefits under this subchapter are paid to a representative payee pursuant to
(Aug. 14, 1935, ch. 531, title XVI, §1636, as added
Editorial Notes
References in Text
The Public Health Service Act, referred to in text, is act July 1, 1944, ch. 373,
Statutory Notes and Related Subsidiaries
Effective Date
Section effective July 1, 1996, with respect to any individual whose claim for benefits is finally adjudicated on or after Mar. 29, 1996, or whose eligibility for benefits is based upon eligibility redetermination made pursuant to section 105(b)(5)(C) of
§1383f. Annual report on program
(a) In general
Not later than May 30 of each year, the Commissioner of Social Security shall prepare and deliver a report annually to the President and the Congress regarding the program under this subchapter, including—
(1) a comprehensive description of the program;
(2) historical and current data on allowances and denials, including number of applications and allowance rates for initial determinations, reconsideration determinations, administrative law judge hearings, appeals council reviews, and Federal court decisions;
(3) historical and current data on characteristics of recipients and program costs, by recipient group (aged, blind, disabled adults, and disabled children);
(4) historical and current data on prior enrollment by recipients in public benefit programs, including State programs funded under part A of subchapter IV of this chapter and State general assistance programs;
(5) projections of future number of recipients and program costs, through at least 25 years;
(6) number of redeterminations and continuing disability reviews, and the outcomes of such redeterminations and reviews;
(7) data on the utilization of work incentives;
(8) detailed information on administrative and other program operation costs;
(9) summaries of relevant research undertaken by the Social Security Administration, or by other researchers;
(10) State supplementation program operations;
(11) a historical summary of statutory changes to this subchapter; and
(12) such other information as the Commissioner deems useful.
(b) Views of individual members of Social Security Advisory Board
Each member of the Social Security Advisory Board shall be permitted to provide an individual report, or a joint report if agreed, of views of the program under this subchapter, to be included in the annual report required under this section.
(Aug. 14, 1935, ch. 531, title XVI, §1637, as added
§1384. Omitted
Editorial Notes
Codification
Section, act Aug. 14, 1935, ch. 531, title XVI, §1604, as added July 25, 1962,
Statutory Notes and Related Subsidiaries
Puerto Rico, Guam, and Virgin Islands
Enactment of subchapter XVI of the Social Security Act [this subchapter] by
§1384. Operation of State plans
If the Commissioner of Social Security, after reasonable notice and opportunity for hearing to the State agency administering or supervising the administration of the State plan approved under this subchapter, finds—
(1) that the plan has been so changed that it no longer complies with the provisions of
(2) that in the administration of the plan there is a failure to comply substantially with any such provision;
the Commissioner of Social Security shall notify such State agency that further payments will not be made to the State (or, in the Commissioner's discretion, that payments will be limited to categories under or parts of the State plan not affected by such failure), until the Commissioner of Social Security is satisfied that there will no longer be any such failure to comply. Until the Commissioner is so satisfied the Commissioner shall make no further payments to such State (or shall limit payments to categories under or parts of the State plan not affected by such failure).
(Aug. 14, 1935, ch. 531, title XVI, §1604, as added July 25, 1962,
[Amendment by section 107(a)(4) of
§1385. Omitted
Editorial Notes
Codification
Section, act Aug. 14, 1935, ch. 531, title XVI, §1605, as added July 25, 1962,
Statutory Notes and Related Subsidiaries
Puerto Rico, Guam, and Virgin Islands
Enactment of subchapter XVI of the Social Security Act [this subchapter] by section 301 of
§1385. Definitions
(a) For purposes of this subchapter, the term "aid to the aged, blind, or disabled" means money payments to needy individuals who are 65 years of age or older, are blind, or are 18 years of age or over and permanently and totally disabled, but such term does not include—
(1) any such payments to or care in behalf of any individual who is an inmate of a public institution (except as a patient in a medical institution); or
(2) any such payments to or care in behalf of any individual who has not attained 65 years of age and who is a patient in an institution for tuberculosis or mental diseases.
Such term also includes payments which are not included within the meaning of such term under the preceding sentence, but which would be so included except that they are made on behalf of such a needy individual to another individual who (as determined in accordance with standards prescribed by the Commissioner of Social Security) is interested in or concerned with the welfare of such needy individual, but only with respect to a State whose State plan approved under
(A) determination by the State agency that such needy individual has, by reason of his physical or mental condition, such inability to manage funds that making payments to him would be contrary to his welfare and, therefore, it is necessary to provide such aid through payments described in this sentence;
(B) making such payments only in cases in which such payments will, under the rules otherwise applicable under the State plan for determining need and the amount of aid to the aged, blind, or disabled to be paid (and in conjunction with other income and resources), meet all the need [sic] of the individuals with respect to whom such payments are made;
(C) undertaking and continuing special efforts to protect the welfare of such individual and to improve, to the extent possible, his capacity for self-care and to manage funds;
(D) periodic review by such State agency of the determination under clause (A) of this subsection to ascertain whether conditions justifying such determination still exist, with provision for termination of such payments if they do not and for seeking judicial appointment of a guardian or other legal representative, as described in
(E) opportunity for a fair hearing before the State agency on the determination referred to in clause (A) of this subsection for any individual with respect to whom it is made.
At the option of a State (if its plan approved under this subchapter so provides), such term (i) need not include money payments to an individual who has been absent from such State for a period in excess of ninety consecutive days (regardless of whether he has maintained his residence in such State during such period) until he has been present in such State for thirty consecutive days in the case of such an individual who has maintained his residence in such State during such period or ninety consecutive days in the case of any other such individual, and (ii) may include rent payments made directly to a public housing agency on behalf of a recipient or a group or groups of recipients of aid under such plan.
(b) Repealed.
(Aug. 14, 1935, ch. 531, title XVI, §1605, as added July 25, 1962,
[Amendment by section 107(a)(4) of