[Code of Federal Regulations]
[Title 20, Volume 2]
[Revised as of January 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 20CFR404]
[Page 45-631]
TITLE 20--EMPLOYEES' BENEFITS
CHAPTER III--SOCIAL SECURITY ADMINISTRATION
PART 404_FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE
(1950)--Table of Contents
Subpart A_Introduction, General Provisions and Definitions
Sec.
404.1 Introduction.
404.2 General definitions and use of terms.
404.3 General provisions.
Subpart B_Insured Status and Quarters of Coverage
General
404.101 Introduction.
404.102 Definitions.
Fully Insured Status
404.110 How we determine fully insured status.
404.111 When we consider a person fully insured based on World War II
active military or naval service.
404.112 When we consider certain employees of private nonprofit
organizations to be fully insured.
404.115 Table for determining the quarters of coverage you need to be
fully insured.
Currently Insured Status
404.120 How we determine currently insured status.
Disability Insured Status
404.130 How we determine disability insured status.
404.131 When you must have disability insured status.
404.132 How we determine fully insured status for a period of disability
or disability insurance benefits.
404.133 When we give you quarters of coverage based on military service
to establish a period of disability.
Quarters of Coverage
404.140 What is a quarter of coverage.
404.141 How we credit quarters of coverage for calendar years before
1978.
404.142 How we credit self-employment income to calendar quarters for
taxable years beginning before 1978.
404.143 How we credit quarters of coverage for calendar years after
1977.
404.144 How we credit self-employment income to calendar years for
taxable years beginning after 1977.
404.145 When you acquire a quarter of coverage.
404.146 When a calendar quarter cannot be a quarter of coverage.
[[Page 46]]
Appendix to Subpart B--Quarter of Coverage Amounts for Calendar Years
After 1978
Subpart C_Computing Primary Insurance Amounts
General
404.201 What is included in this subpart?
404.202 Other regulations related to this subpart.
404.203 Definitions.
404.204 Methods of computing primary insurance amounts--general.
Average-Indexed-Monthly Earnings Method of Computing Primary Insurance
Amounts
404.210 Average-indexed-monthly-earnings method.
404.211 Computing your average indexed monthly earnings.
404.212 Computing your primary insurance amount from your average
indexed monthly earnings.
404.213 Computation where you are eligible for a pension based on your
noncovered employment.
Average-Monthly-Wage Method of Computing Primary Insurance Amounts
404.220 Average-monthly-wage method.
404.221 Computing your average monthly wage.
404.222 Use of benefit table in finding your primary insurance amount
from your average monthly wage.
Guaranteed Alternative for People Reaching Age 62 After 1978 but Before
1984
404.230 Guaranteed alternative.
404.231 Steps in computing your primary insurance amount under the
guaranteed alternative--general.
404.232 Computing your average monthly wage under the guaranteed
alternative.
404.233 Adjustment of your guaranteed alternative when you become
entitled after age 62.
Old-Start Method of Computing Primary Insurance Amounts
404.240 Old-start method--general.
404.241 1977 simplified old-start method.
404.242 Use of old-start primary insurance amount as guaranteed
alternative.
404.243 Computation where you are eligible for a pension based on
noncovered employment.
Special Computation Rules for People Who Had a Period of Disability
404.250 Special computation rules for people who had a period of
disability.
404.251 Subsequent entitlement to benefits less than 12 months after
entitlement to disability benefits ended.
404.252 Subsequent entitlement to benefits 12 months or more after
entitlement to disability benefits ended.
Special Minimum Primary Insurance Amounts
404.260 Special minimum primary insurance amounts.
404.261 Computing your special minimum primary insurance amount.
Cost-of-Living Increases
404.270 Cost-of-living increases.
404.271 When automatic cost-of-living increases apply.
404.272 Indexes we use to measure the rise in the cost-of-living.
404.273 When are automatic cost-of-living increases effective?
404.274 What are the measuring periods we use to calculate cost-of-
living increases?
404.275 How is an automatic cost-of-living increase calculated?
404.276 Publication of notice of increase.
404.277 When does the frozen minimum primary insurance amount increase
because of cost-of-living adjustments?
404.278 Additional cost-of-living increase.
Recomputing Your Primary Insurance Amount
404.280 Recomputations.
404.281 Why your primary insurance amount may be recomputed.
404.282 Effective date of recomputations.
404.283 Recomputation under method other than that used to find your
primary insurance amount.
404.284 Recomputations for people who reach age 62, or become disabled,
or die before age 62 after 1978.
404.285 Recomputations performed automatically.
404.286 How to request an immediate recomputation.
404.287 Waiver of recomputation.
404.288 Recomputing when you are entitled to a monthly pension based on
noncovered employment.
Recalculations of Primary Insurance Amounts
404.290 Recalculations.
Appendixes to Subpart C--Note
Appendix I to Subpart C--Average of the Total Wages for Years After 1950
Appendix II to Subpart C--Benefit Formulas Used With Average Indexed
Monthly Earnings
Appendix III to Subpart C--Benefit Table
Appendix IV to Subpart C--Earnings Needed for a Year of Coverage After
1950
[[Page 47]]
Appendix V to Subpart C--Computing the Special Minimum Primary Insurance
Amount and Related Maximum Family Benefits
Appendix VI to Subpart C--Percentage of Automatic Increases in Primary
Insurance Amounts Since 1978
Appendix VII to Subpart C--``Old-Law'' Contribution and Benefit Base
Subpart D_Old-Age, Disability, Dependents' and Survivors' Insurance
Benefits; Period of Disability
General
404.301 Introduction.
404.302 Other regulations related to this subpart.
404.303 Definitions.
404.304 What are the general rules on benefit amounts?
404.305 When you may not be entitled to benefits.
Old-Age and Disability Benefits
404.310 When am I entitled to old-age benefits?
404.311 When does my entitlement to old-age benefits begin and end?
404.312 How is my old-age benefit amount calculated?
404.313 What are delayed retirement credits and how do they increase my
old-age benefit amount?
404.315 Who is entitled to disability benefits?
404.316 When entitlement to disability benefits begins and ends.
404.317 How is the amount of my disability benefit calculated?
404.320 Who is entitled to a period of disability.
404.321 When a period of disability begins and ends.
404.322 When you may apply for a period of disability after a delay due
to a physical or mental condition.
404.325 The termination month.
Rules Relating to Continuation of Benefits After Your Impairment Is No
Longer Disabling
404.327 When you are participating in an appropriate program of
vocational rehabilitation services, employment services, or
other support services.
404.328 When your completion of the program, or your continuation in the
program for a specified period of time, will increase the
likelihood that you will not have to return to the disability
benefit rolls.
Benefits for Spouses and Divorced Spouses
404.330 Who is entitled to wife's or husband's benefits.
404.331 Who is entitled to wife's or husband's benefits as a divorced
spouse.
404.332 When wife's and husband's benefits begin and end.
404.333 Wife's and husband's benefit amounts.
404.335 How do I become entitled to widow's or widower's benefits?
404.336 How do I become entitled to widow's or widower's benefits as a
surviving divorced spouse?
404.337 When does my entitlement to widow's and widower's benefits start
and end?
404.338 Widow's and widower's benefits amounts.
404.339 Who is entitled to mother's or father's benefits.
404.340 Who is entitled to mother's or father's benefits as a surviving
divorced spouse.
404.341 When mother's and father's benefits begin and end.
404.342 Mother's and father's benefit amounts.
404.344 Your relationship by marriage to the insured.
404.345 Your relationship as wife, husband, widow, or widower under
State law.
404.346 Your relationship as wife, husband, widow, or widower based upon
a deemed valid marriage.
404.347 ``Living in the same household'' defined.
404.348 When a child living with you is ``in your care''.
404.349 When a child living apart from you is ``in your care''.
Child's Benefits
404.350 Who is entitled to child's benefits.
404.351 Who may be reentitled to child's benefits.
404.352 When does my entitlement to child's benefits begin and end?
404.353 Child's benefit amounts.
404.354 Your relationship to the insured.
404.355 Who is the insured's natural child.
404.356 Who is the insured's legally adopted child.
404.357 Who is the insured's stepchild.
404.358 Who is the insured's grandchild or stepgrandchild.
404.359 Who is the insured's equitably adopted child.
404.360 When a child is dependent upon the insured person.
404.361 When a natural child is dependent.
404.362 When a legally adopted child is dependent.
404.363 When a stepchild is dependent.
[[Page 48]]
404.364 When a grandchild or stepgrandchild is dependent.
404.365 When an equitably adopted child is dependent.
404.366 ``Contributions for support,'' ``one-half support,'' and
``living with'' the insured defined--determining first month
of entitlement.
404.367 When you are a ``full-time elementary or secondary school
student''.
404.368 When you are considered a full-time student during a period of
nonattendance.
Parent's Benefits
404.370 Who is entitled to parent's benefits.
404.371 When parent's benefits begin and end.
404.373 Parent's benefit amounts.
404.374 Parent's relationship to the insured.
Special Payments at Age 72
404.380 General.
404.381 Who is entitled to special age 72 payments.
404.382 When special age 72 payments begin and end.
404.383 Special age 72 payment amounts.
404.384 Reductions, suspensions, and nonpayments of special age 72
payments.
Lump-Sum Death Payment
404.390 General.
404.391 Who is entitled to the lump-sum death payment as a widow or
widower who was living in the same household.
404.392 Who is entitled to the lump-sum death payment when there is no
widow(er) who was living in the same household.
Subpart E_Deductions; Reductions; and Nonpayments of Benefits
404.401 Deduction, reduction, and nonpayment of monthly benefits or
lump-sum death payments.
404.401a When we do not pay benefits because of a disability
beneficiary's work activity.
404.402 Interrelationship of deductions, reductions, adjustments, and
nonpayment of benefits.
404.403 Reduction where total monthly benefits exceed maximum family
benefits payable.
404.404 How reduction for maximum affects insured individual and other
persons entitled on his earnings record.
404.405 Situations where total benefits can exceed maximum because of
``savings clause.''
404.406 Reduction for maximum because of retroactive effect of
application for monthly benefits.
404.407 Reduction because of entitlement to other benefits.
404.408 Reduction of benefits based on disability on account of receipt
of certain other disability benefits provided under Federal,
State, or local laws or plans.
404.408a Reduction where spouse is receiving a Government pension.
404.408b Reduction of retroactive monthly social security benefits where
supplemental security income (SSI) payments were received for
the same period.
404.409 What is full retirement age?
404.410 How does SSA reduce my benefits when my entitlement begins
before full retirement age?
404.411 How are benefits reduced for age when a person is entitled to
two or more benefits?
404.412 After my benefits are reduced for age when and how will
adjustments to that reduction be made?
404.413 After my benefits are reduced for age what happens if there is
an increase in my primary insurance amount?
404.415 Deductions because of excess earnings.
404.417 Deductions because of noncovered remunerative activity outside
the United States; 45 hour and 7-day work test.
404.418 ``Noncovered remunerative activity outside the United States,''
defined.
404.420 Persons deemed entitled to benefits based on an individual's
earnings record.
404.421 How are deductions made when a beneficiary fails to have a child
in his or her care?
404.423 Manner of making deductions.
404.424 Total amount of deductions where more than one deduction event
occurs in a month.
404.425 Total amount of deductions where deduction events occur in more
than 1 month.
404.428 Earnings in a taxable year.
404.429 Earnings; defined.
404.430 Monthly and annual exempt amounts defined; excess earnings
defined.
404.434 Excess earnings; method of charging.
404.435 Excess earnings; months to which excess earnings can or cannot
be charged; grace year defined.
404.436 Excess earnings; months to which excess earnings cannot be
charged because individual is deemed not entitled to benefits.
404.437 Excess earnings; benefit rate subject to deductions because of
excess earnings.
404.439 Partial monthly benefits; excess earnings of the individual
charged against his benefits and the benefits of persons
entitled (or deemed entitled) to benefits on his earnings
record.
404.440 Partial monthly benefits; prorated share of partial payment
exceeds the
[[Page 49]]
benefit before deduction for excess earnings.
404.441 Partial monthly benefits; insured individual and another person
entitled (or deemed entitled) on the same earnings record both
have excess earnings.
404.446 Definition of ``substantial services'' and ``services''.
404.447 Evaluation of factors involved in substantial services test.
404.450 Required reports of work outside the United States or failure to
have care of a child.
404.451 Penalty deductions for failure to report within prescribed time
limit noncovered remunerative activity outside the United
States or not having care of a child.
404.452 Reports to Social Security Administration of earnings; wages;
net earnings from self-employment.
404.453 Penalty deductions for failure to report earnings timely.
404.454 Good cause for failure to make required reports.
404.455 Request by Social Security Administration for reports of
earnings and estimated earnings; effect of failure to comply
with request.
404.456 Current suspension of benefits because an individual works or
engages in self-employment.
404.457 Deductions where taxes neither deducted from wages of certain
maritime employees nor paid.
404.458 Limiting deductions where total family benefits payable would
not be affected or would be only partly affected.
404.459 Penalty for making false or misleading statements or withholding
information.
404.460 Nonpayment of monthly benefits of aliens outside the United
States.
404.461 Nonpayment of lump sum after death of alien outside United
States for more than 6 months.
404.462 Nonpayment of hospital and medical insurance benefits of alien
outside United States for more than 6 months.
404.463 Nonpayment of benefits of aliens outside the United States;
``foreign social insurance system,'' and ``treaty obligation''
exceptions defined.
404.464 How does deportation or removal from the United States affect
the receipt of benefits?
404.465 Conviction for subversive activities; effect on monthly benefits
and entitlement to hospital insurance benefits.
404.466 Conviction for subversive activities; effect on enrollment for
supplementary medical insurance benefits.
404.467 Nonpayment of benefits; individual entitled to disability
insurance benefits or childhood disability benefits based on
statutory blindness is engaging in substantial gainful
activity.
404.468 Nonpayment of benefits to prisoners.
404.469 Nonpayment of benefits where individual has not furnished or
applied for a Social Security number.
404.470 Nonpayment of disability benefits due to noncompliance with
rules regarding treatment for drug addiction or alcoholism.
404.471 Nonpayment of disability benefits for trial work period service
months upon a conviction of fraudulently concealing work
activity.
404.480 Paying benefits in installments: Drug addiction or alcoholism.
Subpart F_Overpayments, Underpayments, Waiver of Adjustment or Recovery
of Overpayments, and Liability of a Certifying Officer
404.501 General applicability of section 204 of the Act.
404.502 Overpayments.
404.502a Notice of right to waiver consideration.
404.503 Underpayments.
404.504 Relation to provisions for reductions and increases.
404.505 Relationship to provisions requiring deductions.
404.506 When waiver may be applied and how to process the request.
404.507 Fault.
404.508 Defeat the purpose of Title II.
404.509 Against equity and good conscience; defined.
404.510 When an individual is ``without fault'' in a deduction
overpayment.
404.510a When an individual is ``without fault'' in an entitlement
overpayment.
404.511 When an individual is at ``fault'' in a deduction overpayment.
404.512 When adjustment or recovery of an overpayment will be waived.
404.513 Liability of a certifying officer.
404.515 Collection and compromise of claims for overpayment.
404.520 Referral of overpayments to the Department of the Treasury for
tax refund offset--General.
404.521 Notice to overpaid individual.
404.522 Review within SSA that an overpayment is past due and legally
enforceable.
404.523 Findings by SSA.
404.524 Review of our records related to the overpayment.
404.525 Suspension of offset.
404.526 Tax refund insufficient to cover amount of overpayment.
404.527 Additional methods for recovery of title II benefit
overpayments.
404.530 Are title VIII and title XVI benefits subject to adjustment to
recover title II overpayments?
404.535 How much will we withhold from your title VIII and title XVI
benefits to recover a title II overpayment?
[[Page 50]]
404.540 Will you receive notice of our intention to apply cross-program
recovery?
404.545 When will we begin cross-program recovery from current monthly
benefits?
Subpart G_Filing of Applications and Other Forms
General Provisions
404.601 Introduction.
404.602 Definitions.
404.603 You must file an application to receive benefits.
Applications
404.610 What makes an application a claim for benefits?
404.611 How do I file an application for Social Security benefits?
404.612 Who may sign an application.
404.613 Evidence of authority to sign an application for another.
404.614 When an application or other form is considered filed.
404.615 Claimant must be alive when an application is filed.
404.617 Pilot program for photographic identification of disability
benefit applicants in designated geographic areas.
Effective Filing Period of Application
404.620 Filing before the first month you meet the requirements for
benefits.
404.621 What happens if I file after the first month I meet the
requirements for benefits?
404.622 Limiting an application.
404.623 Am I required to file for all benefits if I am eligible for old-
age and husband's or wife's benefits?
Filing Date Based on Written Statement
404.630 Use of date of written statement as filing date.
404.631 Statements filed with the Railroad Retirement Board.
404.632 Statements filed with a hospital.
Deemed Filing Date Based on Misinformation
404.633 Deemed filing date in a case of misinformation.
Withdrawal of Application
404.640 Withdrawal of an application.
404.641 Cancellation of a request to withdraw.
Subpart H_Evidence
General
404.701 Introduction.
404.702 Definitions.
404.703 When evidence is needed.
404.704 Your responsibility for giving evidence.
404.705 Failure to give requested evidence.
404.706 Where to give evidence.
404.707 Original records or copies as evidence.
404.708 How we decide what is enough evidence.
404.709 Preferred evidence and other evidence.
Evidence of Age, Marriage, and Death
404.715 When evidence of age is needed.
404.716 Type of evidence of age to be given.
404.720 Evidence of a person's death.
404.721 Evidence to presume a person is dead.
404.722 Rebuttal of a presumption of death.
404.723 When evidence of marriage is required.
404.725 Evidence of a valid ceremonial marriage.
404.726 Evidence of common-law marriage.
404.727 Evidence of a deemed valid marriage.
404.728 Evidence a marriage has ended.
Evidence for Child's and Parent's Benefits
404.730 When evidence of a parent or child relationship is needed.
404.731 Evidence you are a natural parent or child.
404.732 Evidence you are a stepparent or stepchild.
404.733 Evidence you are the legally adopting parent or legally adopted
child.
404.734 Evidence you are an equitably adopted child.
404.735 Evidence you are the grandchild or stepgrandchild.
404.736 Evidence of a child's dependency.
404.745 Evidence of school attendance for child age 18 or older.
404.750 Evidence of a parent's support.
Other Evidence Requirements
404.760 Evidence of living in the same household with insured person.
404.762 Evidence of having a child in your care.
404.770 Evidence of where the insured person had a permanent home.
404.780 Evidence of ``good cause'' for exceeding time limits on
accepting proof of support or application for a lump-sum death
payment.
Subpart I_Records of Earnings
General Provisions
404.801 Introduction.
404.802 Definitions.
404.803 Conclusiveness of the record of your earnings.
[[Page 51]]
Obtaining Earnings Information
404.810 How to obtain a statement of earnings and a benefit estimate
statement.
404.811 The statement of earnings and benefit estimates you requested.
404.812 Statement of earnings and benefit estimates sent without
request.
Correcting the Earnings Record
404.820 Filing a request for correction of the record of your earnings.
404.821 Correction of the record of your earnings before the time limit
ends.
404.822 Correction of the record of your earnings after the time limit
ends.
404.823 Correction of the record of your earnings for work in the employ
of the United States.
Notice of Removal or Reduction of an Entry of Earnings
404.830 Notice of removal or reduction of your wages.
404.831 Notice of removal or reduction of your self-employment income.
Subpart J_Determinations, Administrative Review Process, and Reopening
of Determinations and Decisions
Introduction, Definitions, and Initial Determinations
404.900 Introduction.
404.901 Definitions.
404.902 Administrative actions that are initial determinations.
404.903 Administrative actions that are not initial determinations.
404.904 Notice of the initial determination.
404.905 Effect of an initial determination.
404.906 Testing modifications to the disability determination
procedures.
Reconsideration
404.907 Reconsideration--general.
404.908 Parties to a reconsideration.
404.909 How to request reconsideration.
404.911 Good cause for missing the deadline to request review.
404.913 Reconsideration procedures.
404.914 Disability hearing--general.
404.915 Disability hearing--disability hearing officers.
404.916 Disability hearing--procedures.
404.917 Disability hearing--disability hearing officer's reconsidered
determination.
404.918 Disability hearing--review of the disability hearing officer's
reconsidered determination before it is issued.
404.919 Notice of another person's request for reconsideration.
404.920 Reconsidered determination.
404.921 Effect of a reconsidered determination.
404.922 Notice of a reconsidered determination.
Expedited Appeals Process
404.923 Expedited appeals process--general.
404.924 When the expedited appeals process may be used.
404.925 How to request expedited appeals process.
404.926 Agreement in expedited appeals process.
404.927 Effect of expedited appeals process agreement.
404.928 Expedited appeals process request that does not result in
agreement.
Hearing Before an Administrative Law Judge
404.929 Hearing before an administrative law judge--general.
404.930 Availability of a hearing before an administrative law judge.
404.932 Parties to a hearing before an administrative law judge.
404.933 How to request a hearing before an administrative law judge.
404.935 Submitting evidence prior to a hearing before an administrative
law judge.
404.936 Time and place for a hearing before an administrative law judge.
404.938 Notice of a hearing before an administrative law judge.
404.939 Objections to the issues.
404.940 Disqualification of the administrative law judge.
404.941 Prehearing case review.
404.942 Prehearing proceedings and decisions by attorney advisors.
404.943 Responsibilities of the adjudication officer.
Administrative Law Judge Hearing Procedures
404.944 Administrative law judge hearing procedures--general.
404.946 Issues before an administrative law judge.
404.948 Deciding a case without an oral hearing before an administrative
law judge.
404.949 Presenting written statements and oral arguments.
404.950 Presenting evidence at a hearing before an administrative law
judge.
404.951 When a record of a hearing before an administrative law judge is
made.
404.952 Consolidated hearing before an administrative law judge.
404.953 The decision of an administrative law judge.
404.955 The effect of an administrative law judge's decision.
404.956 Removal of a hearing request from an administrative law judge to
the Appeals Council.
[[Page 52]]
404.957 Dismissal of a request for a hearing before an administrative
law judge.
404.958 Notice of dismissal of a request for a hearing before an
administrative law judge.
404.959 Effect of dismissal of a request for a hearing before an
administrative law judge.
404.960 Vacating a dismissal of a request for a hearing before an
administrative law judge.
404.961 Prehearing and posthearing conferences.
404.965 [Reserved]
Appeals Council Review
404.966 Testing elimination of the request for Appeals Council review.
404.967 Appeals Council review--general.
404.968 How to request Appeals Council review.
404.969 Appeals Council initiates review.
404.970 Cases the Appeals Council will review.
404.971 Dismissal by Appeals Council.
404.972 Effect of dismissal of request for Appeals Council review.
404.973 Notice of Appeals Council review.
404.974 Obtaining evidence from Appeals Council.
404.975 Filing briefs with the Appeals Council.
404.976 Procedures before Appeals Council on review.
404.977 Case remanded by Appeals Council.
404.979 Decision of Appeals Council.
404.981 Effect of Appeals Council's decision or denial of review.
404.982 Extension of time to file action in Federal district court.
Court Remand Cases
404.983 Case remanded by a Federal court.
404.984 Appeals Council review of administrative law judge decision in a
case remanded by a Federal court.
404.985 Application of circuit court law.
Reopening and Revising Determinations and Decisions
404.987 Reopening and revising determinations and decisions.
404.988 Conditions for reopening.
404.989 Good cause for reopening.
404.990 Finality of determinations and decisions on revision of an
earnings record.
404.991 Finality of determinations and decisions to suspend benefit
payments for entire taxable year because of earnings.
404.991a Late completion of timely investigation.
404.992 Notice of revised determination or decision.
404.993 Effect of revised determination or decision.
404.994 Time and place to request a hearing on revised determination or
decision.
404.995 Finality of findings when later claim is filed on same earnings
record.
404.996 Increase in future benefits where time period for reopening
expires.
Payment of Certain Travel Expenses
404.999a Payment of certain travel expenses--general.
404.999b Who may be reimbursed.
404.999c What travel expenses are reimbursable.
404.999d When and how to claim reimbursement.
Subpart K_Employment, Wages, Self-Employment, and Self-Employment Income
404.1001 Introduction.
404.1002 Definitions.
Employment
404.1003 Employment.
404.1004 What work is covered as employment?
404.1005 Who is an employee.
404.1006 Corporation officer.
404.1007 Common-law employee.
404.1008 Agent-driver or commission-driver, full-time life insurance
salesman, home worker, or traveling or city salesman.
404.1009 Who is an employer.
404.1010 Farm crew leader as employer.
Work Excluded From Employment
404.1012 Work excluded from employment.
404.1013 Included-excluded rule.
404.1014 Domestic service by a student for a local college club,
fraternity or sorority.
404.1015 Family services.
404.1016 Foreign agricultural workers.
404.1017 Sharefarmers.
404.1018 Work by civilians for the United States Government or its
instrumentalities--wages paid after 1983.
404.1018a Work by civilians for the United States Government or its
instrumentalities--remuneration paid prior to 1984.
404.1018b Medicare qualified government employment.
404.1019 Work as a member of a uniformed service of the United States.
404.1020 Work for States and their political subdivisions and
instrumentalities.
404.1021 Work for the District of Columbia.
404.1022 American Samoa, Guam, or the Commonwealth of the Northern
Mariana Islands.
404.1023 Ministers of churches and members of religious orders.
404.1024 Election of coverage by religious orders.
404.1025 Work for religious, charitable, educational, or certain other
organizations exempt from income tax.
[[Page 53]]
404.1026 Work for a church or qualified church-controlled organization.
404.1027 Railroad work.
404.1028 Student working for a school, college, or university.
404.1029 Student nurses.
404.1030 Delivery and distribution or sale of newspapers, shopping news,
and magazines.
404.1031 Fishing.
404.1032 Work for a foreign government.
404.1033 Work for a wholly owned instrumentality of a foreign
government.
404.1034 Work for an international organization.
404.1035 Work for a communist organization.
404.1036 Certain nonresident aliens.
404.1037 Work on or in connection with a non-American vessel or
aircraft.
404.1038 Domestic employees under age 18.
Exemption From Social Security by Reason of Religous Belief
404.1039 Employers (including partnerships) and employees who are both
members of certain religious groups opposed to insurance.
Wages
404.1041 Wages.
404.1042 Wages when paid and received.
404.1043 Facilities or privileges--meals and lodging.
404.1044 Vacation pay.
404.1045 Employee expenses.
404.1046 Pay for work by certain members of religious orders.
404.1047 Annual wage limitation.
404.1048 Contribution and benefit base after 1992.
404.1049 Payments under an employer plan or system.
404.1050 Retirement payments.
404.1051 Payments on account of sickness or accident disability, or
related medical or hospitalization expenses.
404.1052 Payments from or to certain tax-exempt trusts or payments under
or into certain annuity plans.
404.1053 ``Qualified benefits'' under a cafeteria plan.
404.1054 Payments by an employer of employee's tax or employee's
contribution under State law.
404.1055 Payments for agricultural labor.
404.1056 Explanation of agricultural labor.
404.1057 Domestic service in the employer's home.
404.1058 Special situations.
404.1059 Deemed wages for certain individuals interned during World War
II.
404.1060 [Reserved]
Self-Employment
404.1065 Self-employment coverage.
404.1066 Trade or business in general.
404.1068 Employees who are considered self-employed.
404.1069 Real estate agents and direct sellers.
404.1070 Christian Science practitioners.
404.1071 Ministers and members of religious orders.
404.1073 Public office.
404.1074 Farm crew leader who is self-employed.
404.1075 Members of certain religious groups opposed to insurance.
404.1077 Individuals under railroad retirement system.
Self-Employment Income
404.1080 Net earnings from self-employment.
404.1081 General rules for figuring net earnings from self-employment.
404.1082 Rentals from real estate; material participation.
404.1083 Dividends and interest.
404.1084 Gain or loss from disposition of property; capital assets;
timber, coal, and iron ore; involuntary conversion.
404.1085 Net operating loss deduction.
404.1086 Community income.
404.1087 Figuring partner's net earnings from self-employment for
taxable year which ends as a result of death.
404.1088 Retirement payment to retired partners.
404.1089 Figuring net earnings for residents and nonresidents of Puerto
Rico.
404.1090 Personal exemption deduction.
404.1091 Figuring net earnings for ministers and members of religious
orders.
404.1092 Figuring net earnings for U.S. citizens or residents living
outside the United States.
404.1093 Possession of the United States.
404.1094 Options available for figuring net earnings from self-
employment.
404.1095 Agricultural trade or business.
404.1096 Self-employment income.
Subpart L [Reserved]
Subpart M_Coverage of Employees of State and Local Governments
General
404.1200 General.
404.1201 Scope of this subpart regarding coverage and wage reports and
adjustments.
404.1202 Definitions.
404.1203 Evidence--for wages paid prior to 1987.
404.1204 Designating officials to act on behalf of the State.
What Groups of Employees May Be Covered
404.1205 Absolute coverage groups.
[[Page 54]]
404.1206 Retirement system coverage groups.
404.1207 Divided retirement system coverage groups.
404.1208 Ineligible employees.
404.1209 Mandatorily excluded services.
404.1210 Optionally excluded services.
404.1211 Interstate instrumentalities.
404.1212 Police officers and firefighters.
How Coverage Under Agreements Is Obtained and Continues
404.1214 Agreement for coverage.
404.1215 Modification of agreement.
404.1216 Modification of agreement to correct an error.
404.1217 Continuation of coverage.
404.1218 Resumption of coverage.
404.1219 Dissolution of political subdivision.
How To Identify Covered Employees
404.1220 Identification numbers.
What Records of Coverage Must Be Kept
404.1225 Records--for wages paid prior to 1987.
Review of Compliance by State With Its Agreement
404.1230 Onsite review program.
404.1231 Scope of review.
404.1232 Conduct of review.
404.1234 Reports of review's findings.
How To Report Wages and Contributions--for Wages Paid Prior to 1987
404.1237 Wage reports and contribution returns--general--for wages paid
prior to 1987.
404.1239 Wage reports for employees performing services in more than one
coverage group--for wages paid prior to 1987.
404.1242 Back pay.
404.1243 Use of reporting forms--for wages paid prior to 1987.
404.1247 When to report wages--for wages paid prior to 1987.
404.1249 When and where to make deposits of contributions and to file
contribution returns and wage reports--for wages paid prior to
1987.
404.1251 Final reports--for wages paid prior to 1987.
What Is a State's Liability for Contributions--for Wages Paid Prior to
1987
404.1255 State's liability for contributions--for wages paid prior to
1987.
404.1256 Limitation on State's liability for contributions for multiple
employment situations--for wages paid prior to 1987.
Figuring the Amount of the State's Contributions--for Wages Paid Prior
to 1987
404.1260 Amount of contributions--for wages paid prior to 1987.
404.1262 Manner of payment of contributions by State--for wages paid
prior to 1987.
404.1263 When fractional part of a cent may be disregarded--for wages
paid prior to 1987.
If a State Fails To Make Timely Payments--for Wages Paid Prior to 1987
404.1265 Addition of interest to contributions--for wages paid prior to
1987.
404.1267 Failure to make timely payments--for wages paid prior to 1987.
How Errors in Reports and Contributions Are Adjusted--for Wages Paid
Prior to 1987
404.1270 Adjustments in general--for wages paid prior to 1987.
404.1271 Adjustment of overpayment of contributions--for wages paid
prior to 1987.
404.1272 Refund or recomputation of overpayments which are not
adjustable--for wages paid prior to 1987.
404.1275 Adjustment of employee contributions--for wages paid prior to
1987.
404.1276 Reports and payments erroneously made to Internal Revenue
Service-transfer of funds--for wages paid prior to 1987.
How Overpayments of Contributions Are Credited or Refunded--for Wages
Paid Prior to 1987
404.1280 Allowance of credits or refunds--for wages paid prior to 1987.
404.1281 Credits or refunds for periods of time during which no
liability exists--for wages paid prior to 1987.
404.1282 Time limitations on credits or refunds--for wages paid prior to
1987.
404.1283 Exceptions to the time limitations on credits or refunds--for
wages paid prior to 1987.
404.1284 Offsetting underpayments against overpayments--for wages paid
prior to 1987.
How Assessments for Underpayments of Contributions Are Made--for Wages
Paid Prior to 1987
404.1285 Assessments of amounts due--for wages paid prior to 1987.
404.1286 Time limitations on assessments--for wages paid prior to 1987.
404.1287 Exceptions to the time limitations on assessments--for wages
paid prior to 1987.
404.1289 Payment after expiration of time limitation for assessment--for
wages paid prior to 1987.
[[Page 55]]
Secretary's Review of Decisions on Credits, Refunds, or Assessments--for
Wages Paid Prior to 1987
404.1290 Review of decisions by the Secretary--for wages paid prior to
1987.
404.1291 Reconsideration--for wages paid prior to 1987.
404.1292 How to request review--for wages paid prior to 1987.
404.1293 Time for filing request for review--for wages paid prior to
1987.
404.1294 Notification to State after reconsideration--for wages paid
prior to 1987.
404.1295 Commissioner's review--for wages paid prior to 1987.
404.1296 Commissioner's notification to the State--for wages paid prior
to 1987.
How a State May Seek Court Review of Secretary's Decision--for Wages
Paid Prior to 1987
404.1297 Review by court--for wages paid prior to 1987.
404.1298 Time for filing civil action--for wages paid prior to 1987.
404.1299 Final judgments--for wages paid prior to 1987.
Subpart N_Wage Credits for Veterans and Members of the Uniformed
Services
General
404.1301 Introduction.
404.1302 Definitions.
World War II Veterans
404.1310 Who is a World War II veteran.
404.1311 Ninety-day active service requirement for World War II
veterans.
404.1312 World War II service included.
404.1313 World War II service excluded.
Post-World War II Veterans
404.1320 Who is a post-World War II veteran.
404.1321 Ninety-day active service requirement for post-World War II
veterans.
404.1322 Post-World War II service included.
404.1323 Post-World War II service excluded.
Separation From Active Service
404.1325 Separation from active service under conditions other than
dishonorable.
Members of the Uniformed Services
404.1330 Who is a member of a uniformed service.
Amounts of Wage Credits and Limits on Their Use
404.1340 Wage credits for World War II and post-World War II veterans.
404.1341 Wage credits for a member of a uniformed service.
404.1342 Limits on granting World War II and post-World War II wage
credits.
404.1343 When the limits on granting World War II and post-World War II
wage credits do not apply.
Deemed Insured Status for World War II Veterans
404.1350 Deemed insured status.
404.1351 When deemed insured status does not apply.
404.1352 Benefits and payments based on deemed insured status.
Effect of Other Benefits on Payment of Social Security Benefits and
Payments
404.1360 Veterans Administration pension or compensation payable.
404.1361 Federal benefit payable other than by Veterans Administration.
404.1362 Treatment of social security benefits or payments where
Veterans Administration pension or compensation payable.
404.1363 Treatment of social security benefits or payments where Federal
benefit payable other than by Veterans Administration.
Evidence of Active Service and Membership in a Uniformed Service
404.1370 Evidence of active service and separation from active service.
404.1371 Evidence of membership in a uniformed service during the years
1957 through 1967.
Subpart O_Interrelationship of Old-Age, Survivors and Disability
Insurance Program With the Railroad Retirement Program
404.1401 What is the interrelationship between the Railroad Retirement
Act and the Old-Age, Survivors and Disability Insurance
Program of the Social Security Act?
404.1402 When are railroad industry services by a non-vested worker
covered under Social Security?
404.1404 Effective date of coverage of railroad services under the act.
404.1405 If you have been considered a non-vested worker, what are the
situations when your railroad industry work will not be
covered under Social Security?
404.1406 Eligibility to railroad retirement benefits as a bar to payment
of social security benefits.
404.1407 When railroad retirement benefits do not bar payment of social
security benefits.
404.1408 Compensation to be treated as wages.
404.1409 Purposes of using compensation.
[[Page 56]]
404.1410 Presumption on basis of certified compensation record.
404.1412 Compensation quarters of coverage.
404.1413 When will we certify payment to the Railroad Retirement Board
(RRB)?
Subpart P_Determining Disability and Blindness
General
404.1501 Scope of subpart.
404.1502 General definitions and terms for this subpart.
Determinations
404.1503 Who makes disability and blindness determinations.
404.1503a Program integrity.
404.1504 Determinations by other organizations and agencies.
Definition of Disability
404.1505 Basic definition of disability.
404.1506 When we will not consider your impairment.
404.1508 What is needed to show an impairment.
404.1509 How long the impairment must last.
404.1510 Meaning of substantial gainful activity.
404.1511 Definition of disabling impairment.
Evidence
404.1512 Evidence.
404.1513 Medical and other evidence of your impairment(s).
404.1514 When we will purchase existing evidence.
404.1515 Where and how to submit evidence.
404.1516 If you fail to submit medical and other evidence.
404.1517 Consultative examination at our expense.
404.1518 If you do not appear at a consultative examination.
Standards To Be Used in Determining When a Consultative Examination Will
Be Obtained in Connection With Disability Determinations
404.1519 The consultative examination.
404.1519a When we will purchase a consultative examination and how we
will use it.
404.1519b When we will not purchase a consultative examination.
Standards for the Type of Referral and for Report Content
404.1519f Type of purchased examinations.
404.1519g Who we will select to perform a consultative examination.
404.1519h Your treating source.
404.1519i Other sources for consultative examinations.
404.1519j Objections to the medical source designated to perform the
consultative examination.
404.1519k Purchase of medical examinations, laboratory tests, and other
services.
404.1519m Diagnostic tests or procedures.
404.1519n Informing the medical source of examination scheduling, report
content, and signature requirements.
404.1519o When a properly signed consultative examination report has not
been received.
404.1519p Reviewing reports of consultative examinations.
404.1519q Conflict of interest.
Authorizing and Monitoring the Referral Process
404.1519s Authorizing and monitoring the consultative examination.
Procedures To Monitor the Consultative Examination
404.1519t Consultative examination oversight.
Evaluation of Disability
404.1520 Evaluation of disability in general.
404.1520a Evaluation of mental impairments.
404.1521 What we mean by an impairment(s) that is not severe.
404.1522 When you have two or more unrelated impairments--initial
claims.
404.1523 Multiple impairments.
Medical Considerations
404.1525 Listing of Impairments in appendix 1.
404.1526 Medical equivalence.
404.1527 Evaluating opinion evidence.
404.1528 Symptoms, signs, and laboratory findings.
404.1529 How we evaluate symptoms, including pain.
404.1530 Need to follow prescribed treatment.
404.1535 How we will determine whether your drug addiction or alcoholism
is a contributing factor material to the determination of
disability.
404.1536 Treatment required for individuals whose drug addiction or
alcoholism is a contributing factor material to the
determination of disability.
404.1537 What we mean by appropriate treatment.
404.1538 What we mean by approved institutions or facilities.
404.1539 How we consider whether treatment is available.
404.1540 Evaluating compliance with the treatment requirements.
[[Page 57]]
404.1541 Establishment and use of referral and monitoring agencies.
Residual Functional Capacity
404.1545 Your residual functional capacity.
404.1546 Responsibility for assessing your residual functional capacity.
Vocational Considerations
404.1560 When we will consider your vocational background.
404.1562 Medical-vocational profiles showing an inability to make an
adjustment to other work.
404.1563 Your age as a vocational factor.
404.1564 Your education as a vocational factor.
404.1565 Your work experience as a vocational factor.
404.1566 Work which exists in the national economy.
404.1567 Physical exertion requirements.
404.1568 Skill requirements.
404.1569 Listing of Medical-Vocational Guidelines in appendix 2.
404.1569a Exertional and nonexertional limitations.
Substantial Gainful Activity
404.1571 General.
404.1572 What we mean by substantial gainful activity.
404.1573 General information about work activity.
404.1574 Evaluation guides if you are an employee.
404.1574a When and how we will average your earnings.
404.1575 Evaluation guides if you are self-employed.
404.1576 Impairment-related work expenses.
Widows, Widowers, and Surviving Divorced Spouses
404.1577 Disability defined for widows, widowers, and surviving divorced
spouses for monthly benefits payable for months prior to
January 1991.
404.1578 How we determine disability for widows, widowers, and surviving
divorced spouses for monthly benefits payable for months prior
to January 1991.
404.1579 How we will determine whether your disability continues or
ends.
Blindness
404.1581 Meaning of blindness as defined in the law.
404.1582 A period of disability based on blindness.
404.1583 How we determine disability for blind persons who are age 55 or
older.
404.1584 Evaluation of work activity of blind people.
404.1585 Trial work period for persons age 55 or older who are blind.
404.1586 Why and when we will stop your cash benefits.
404.1587 Circumstances under which we may suspend and terminate your
benefits before we make a determination.
Continuing or Stopping Disability
404.1588 Your responsibility to tell us of events that may change your
disability status.
404.1589 We may conduct a review to find out whether you continue to be
disabled.
404.1590 When and how often we will conduct a continuing disability
review.
404.1591 If your medical recovery was expected and you returned to work.
404.1592 The trial work period.
404.1592a The reentitlement period.
404.1592b What is expedited reinstatement?
404.1592c Who is entitled to expedited reinstatement?
404.1592d How do I request reinstatement?
404.1592e How do we determine provisional benefits?
404.1592f How do we determine reinstated benefits?
404.1593 Medical evidence in continuing disability review cases.
404.1594 How we will determine whether your disability continues or
ends.
404.1595 When we determine that you are not now disabled.
404.1596 Circumstances under which we may suspend and terminate your
benefits before we make a determination.
404.1597 After we make a determination that you are not now disabled.
404.1597a Continued benefits pending appeal of a medical cessation
determination.
404.1598 If you become disabled by another impairment(s).
404.1599 Work incentive experiments and rehabilitation demonstration
projects in the disability program.
Appendix 1 to Subpart P--Listing of Impairments
Appendix 2 to Subpart P--Medical-Vocational Guidelines
Subpart Q_Determinations of Disability
General Provisions
404.1601 Purpose and scope.
404.1602 Definitions.
404.1603 Basic responsibilities for us and the State.
Responsibilities for Performing the Disability Determination Function
404.1610 How a State notifies us that it wishes to perform the
disability determination function.
404.1611 How we notify a State whether it may perform the disability
determination function.
[[Page 58]]
404.1613 Disability determinations the State makes.
404.1614 Responsibilities for obtaining evidence to make disability
determinations.
404.1615 Making disability determinations.
404.1616 Medical or psychological consultants.
404.1617 Reasonable efforts to obtain review by a qualified psychiatrist
or psychologist.
404.1618 Notifying claimants of the disability determination.
Administrative Responsibilities and Requirements
404.1620 General administrative requirements.
404.1621 Personnel.
404.1622 Training.
404.1623 Facilities.
404.1624 Medical and other purchased services.
404.1625 Records and reports.
404.1626 Fiscal.
404.1627 Audits.
404.1628 Property.
404.1629 Participation in research and demonstration projects.
404.1630 Coordination with other agencies.
404.1631 Confidentiality of information and records.
404.1632 Other Federal laws and regulations.
404.1633 Policies and operating instructions.
Performance Standards
404.1640 General.
404.1641 Standards of performance.
404.1642 Processing time standards.
404.1643 Performance accuracy standard.
404.1644 How and when we determine whether the processing time standards
are met.
404.1645 How and when we determine whether the performance accuracy
standard is met.
404.1650 Action we will take if a State agency does not meet the
standards.
Performance Monitoring and Support
404.1660 How we will monitor.
404.1661 When we will provide performance support.
404.1662 What support we will provide.
Substantial Failure
404.1670 General.
404.1671 Good cause for not following the Act, our regulations, or other
written guidelines.
404.1675 Finding of substantial failure.
Hearings and Appeals
404.1680 Notice of right to hearing on proposed finding of substantial
failure.
404.1681 Disputes on matters other than substantial failure.
404.1682 Who conducts the hearings.
404.1683 Hearings and appeals process.
Assumption of Disability Determination Function
404.1690 Assumption when we make a finding of substantial failure.
404.1691 Assumption when State no longer wishes to perform the
disability determination function.
404.1692 Protection of State employees.
404.1693 Limitation on State expenditures after notice.
404.1694 Final accounting by the State.
Subpart R_Representation of Parties
404.1700 Introduction.
404.1703 Definitions.
404.1705 Who may be your representative.
404.1706 Notification of options for obtaining attorney representation.
404.1707 Appointing a representative.
404.1710 Authority of a representative.
404.1715 Notice or request to a representative.
404.1720 Fee for a representative's services.
404.1725 Request for approval of a fee.
404.1728 Proceedings before a State or Federal court.
404.1730 Payment of fees.
404.1735 Services in a proceeding under title II of the Act.
404.1740 Rules of conduct and standards of responsibility for
representatives.
404.1745 Violations of our requirements, rules, or standards.
404.1750 Notice of charges against a representative.
404.1755 Withdrawing charges against a representative.
404.1765 Hearing on charges.
404.1770 Decision by hearing officer.
404.1775 Requesting review of the hearing officer's decision.
404.1776 Assignment of request for review of the hearing officer's
decision.
404.1780 Appeals Council's review of hearing officer's decision.
404.1785 Evidence permitted on review.
404.1790 Appeals Council's decision.
404.1795 When the Appeals Council will dismiss a request for review.
404.1797 Reinstatement after suspension--period of suspension expired.
404.1799 Reinstatement after suspension or disqualification--period of
suspension not expired.
Subpart S_Payment Procedures
404.1800 Introduction.
404.1805 Paying benefits.
404.1807 Monthly payment day.
404.1810 Expediting benefit payments.
404.1815 Withholding certification or payments.
[[Page 59]]
404.1820 Transfer or assignment of payments.
404.1825 Joint payments to a family.
Subpart T_Totalization Agreements
General Provisions
404.1901 Introduction.
404.1902 Definitions.
404.1903 Negotiating totalization agreements.
404.1904 Effective date of a totalization agreement.
404.1905 Termination of agreements.
Benefit Provisions
404.1908 Crediting foreign periods of coverage.
404.1910 Person qualifies under more than one totalization agreement.
404.1911 Effects of a totalization agreement on entitlement to hospital
insurance benefits.
Coverage Provisions
404.1913 Precluding dual coverage.
404.1914 Certificate of coverage.
404.1915 Payment of contributions.
Computation Provisions
404.1918 How benefits are computed.
404.1919 How benefits are recomputed.
404.1920 Supplementing the U.S. benefit if the total amount of the
combined benefits is less than the U.S. minimum benefit.
404.1921 Benefits of less than $1 due.
Other Provisions
404.1925 Applications.
404.1926 Evidence.
404.1927 Appeals.
404.1928 Effect of the alien non-payment provision.
404.1929 Overpayments.
404.1930 Disclosure of information.
Subpart U_Representative Payment
404.2001 Introduction.
404.2010 When payment will be made to a representative payee.
404.2011 What happens to your monthly benefits while we are finding a
suitable representative payee for you?
404.2015 Information considered in determining whether to make
representative payments.
404.2020 Information considered in selecting a representative payee.
404.2021 What is our order of preference in selecting a representative
payee for you?
404.2022 Who may not serve as a representative payee?
404.2024 How do we investigate a representative payee applicant?
404.2025 What information must a representative payee report to us?
404.2030 How will we notify you when we decide you need a representative
payee?
404.2035 What are the responsibilities of your representative payee?
404.2040 Use of benefit payments.
404.2040a Compensation for qualified organizations serving as
representative payees.
404.2041 Who is liable if your representative payee misuses your
benefits?
404.2045 Conservation and investment of benefit payments.
404.2050 When will we select a new representative payee for you?
404.2055 When representative payment will be stopped.
404.2060 Transfer of accumulated benefit payments.
404.2065 How does your representative payee account for the use of
benefits?
Subpart V_Payments for Vocational Rehabilitation Services
General Provisions
404.2101 General.
404.2102 Purpose and scope.
404.2103 Definitions.
404.2104 Participation by State VR agencies or alternate participants.
404.2106 Basic qualifications for alternate participants.
Payment Provisions
404.2108 Requirements for payment.
404.2109 Responsibility for making payment decisions.
404.2110 What we mean by ``SGA'' and by ``a continuous period of 9
months''.
404.2111 Criteria for determining when VR services will be considered to
have contributed to a continuous period of 9 months.
404.2112 Payment for VR services in a case where an individual continues
to receive disability payments based on participation in an
approved VR program.
404.2114 Services for which payment may be made.
404.2115 When services must have been provided.
404.2116 When claims for payment for VR services must be made (filing
deadlines).
404.2117 What costs will be paid.
Administrative Provisions
404.2118 Applicability of these provisions to alternate participants.
404.2119 Method of payment.
404.2120 Audits.
404.2121 Validation reviews.
404.2122 Confidentiality of information and records.
404.2123 Other Federal laws and regulations.
404.2127 Resolution of disputes.
[[Page 60]]
Subpart A_Introduction, General Provisions and Definitions
Authority: Secs. 203, 205(a), 216(j), and 702(a)(5) of the Social
Security Act (42 U.S.C. 403, 405(a), 416(j), and 902(a)(5)) and 48
U.S.C. 1801.
Sec.404.1 Introduction.
The regulations in this part 404 (Regulations No. 4 of the Social
Security Administration) relate to the provisions of title II of the
Social Security Act as amended on August 28, 1950, and as further
amended thereafter. The regulations in this part are divided into 22
subparts:
(a) Subpart A contains provisions relating to general definitions
and use of terms.
(b) Subpart B relates to quarters of coverage and insured status
requirements.
(c) Subpart C relates to the computation and recomputation of the
primary insurance amount.
(d) Subpart D relates to the requirements for entitlement to monthly
benefits and to the lump-sum death payment duration of entitlement and
benefit rates.
(e) Subpart E contains provisions relating to the reduction and
increase of insurance benefits and to deductions from benefits and lump-
sum death payments.
(f) Subpart F relates to overpayments, underpayments, waiver of
adjustment or recovery of overpayments and liability of certifying
officers.
(g) Subpart G relates to filing of applications and other forms.
(h) Subpart H relates to evidentiary requirements for establishing
an initial and continuing right to monthly benefits and for establishing
a right to lump-sum death payment. (Evidentiary requirements relating to
disability are contained in subpart P.)
(i) Subpart I relates to maintenance and revision of records of
wages and self-employment income.
(j) Subpart J relates to initial determinations, the administrative
review process, and reopening of determinations and decisions.
(k) Subpart K relates to employment, wages, self-employment and
self-employment income.
(l) Subpart L is reserved.
(m) Subpart M relates to coverage of employees of State and local
Governments.
(n) Subpart N relates to benefits in cases involving veterans.
(o) Subpart O relates to the interrelationship of the old-age,
survivors and disability insurance program with the railroad retirement
program.
(p) Subpart P relates to the determination of disability or
blindness.
(q) Subpart Q relates to standards, requirements and procedures for
States making determinations of disability for the Commissioner. It also
sets out the Commissioner's responsibilities in carrying out the
disability determination function.
(r) Subpart R relates to the provisions applicable to attorneys and
other individuals who represent applicants in connection with claims for
benefits.
(s) Subpart S relates to the payment of benefits to individuals who
are entitled to benefits.
(t) Subpart T relates to the negotiation and administration of
totalization agreements between the United States and foreign countries.
(u) Subpart U relates to the selection of a representative payee to
receive benefits on behalf of a beneficiary and to the duties and
responsibilities of a representative payee.
(v) Subpart V relates to payments to State vocational rehabilitative
agencies (or alternate participants) for vocational rehabilitation
services.
[26 FR 7054, Aug. 5, 1961; 26 FR 7760, Aug. 19, 1961, as amended at 27
FR 4513, May 11, 1962; 28 FR 14492, Dec. 31, 1963; 51 FR 11718, Apr. 7,
1986; 62 FR 38450, July 18, 1997]
Sec.404.2 General definitions and use of terms.
(a) Terms relating to the Act and regulations. (1) The Act means the
Social Security Act, as amended (42 U.S.C. Chapter 7).
(2) Section means a section of the regulations in part 404 of this
chapter unless the context indicates otherwise.
(b) Commissioner; Appeals Council; Administrative Law Judge defined.
(1) Commissioner means the Commissioner of Social Security.
(2) Appeals Council means the Appeals Council of the Office of
Hearings and
[[Page 61]]
Appeals in the Social Security Administration or such member or members
thereof as may be designated by the Chairman.
(3) Administrative Law Judge means an Administrative Law Judge in
the Office of Hearings and Appeals in the Social Security
Administration.
(c) Miscellaneous. (1) Certify, when used in connection with the
duty imposed on the Commissioner by section 205(i) of the act, means
that action taken by the Administration in the form of a written
statement addressed to the Managing Trustee, setting forth the name and
address of the person to whom payment of a benefit or lump sum, or any
part thereof, is to be made, the amount to be paid, and the time at
which payment should be made.
(2) Benefit means an old-age insurance benefit, disability insurance
benefit, wife's insurance benefit, husband's insurance benefit, child's
insurance benefit, widow's insurance benefit, widower's insurance
benefit, mother's insurance benefit, father's insurance benefit,
parent's insurance benefit, or special payment at age 72 under title II
of the Act. (Lump sums, which are death payments under title II of the
Act, are excluded from the term benefit as defined in this part to
permit greater clarity in the regulations.)
(3) Lump sum means a lump-sum death payment under title II of the
act or any person's share of such a payment.
(4) Attainment of age. An individual attains a given age on the
first moment of the day preceding the anniversary of his birth
corresponding to such age.
(5) State, unless otherwise indicated, includes:
(i) The District of Columbia,
(ii) The Virgin Islands,
(iii) The Commonwealth of Puerto Rico effective January 1, 1951,
(iv) Guam and American Samoa, effective September 13, 1960,
generally, and for purposes of sections 210(a) and 211 of the Act
effective after 1960 with respect to service performed after 1960, and
effective for taxable years beginning after 1960 with respect to
crediting net earnings from self-employment and self-employment income,
(v) The Territories of Alaska and Hawaii prior to January 3, 1959,
and August 21, 1959, respectively, when those territories acquired
statehood, and
(vi) The Commonwealth of the Northern Mariana Islands effective
January 1, 1987; Social Security coverage for affected employees of the
government of the CNMI is also effective on January 1, 1987, under
section 210(a)(7)(E) of the Social Security Act.
(6) United States, when used in a geographical sense, includes,
unless otherwise indicated:
(i) The States,
(ii) The Territories of Alaska and Hawaii prior to January 3, 1959,
and August 21, 1959, respectively, when they acquired statehood,
(iii) The District of Columbia,
(iv) The Virgin Islands,
(v) The Commonwealth of Puerto Rico effective January 1, 1951, (vi)
Guam and American Samoa, effective September 13, 1960, generally, and
for purposes of sections 210(a) and 211 of the Act, effective after 1960
with respect to service performed after 1960, and effective for taxable
years beginning after 1960 with respect to crediting net earnings from
self-employment and self-employment income, and
(vii) The Commonwealth of the Northern Mariana Islands effective
January 1, 1987.
(7) Masculine gender includes the feminine, unless otherwise
indicated.
(8) The terms defined in sections 209, 210, and 211 of the act shall
have the meanings therein assigned to them.
[26 FR 7055, Aug. 5, 1961; 26 FR 7760, Aug. 19, 1961, as amended at 28
FR 1037, Feb. 2, 1963; 28 FR 14492, Dec. 31, 1963; 29 FR 15509, Nov. 19,
1964; 41 FR 32886, Aug. 6, 1976; 51 FR 11718, Apr. 7, 1986; 61 FR 41330,
Aug. 8, 1996; 62 FR 38450, July 18, 1997; 69 FR 51555, Aug. 20, 2004]
Sec.404.3 General provisions.
(a) Effect of cross references. The cross references in the
regulations in this part 404 to other portions of the regulations, when
the word see is used, are made only for convenience and shall be given
no legal effect.
(b) Periods of limitation ending on nonwork days. Pursuant to the
provisions of section 216(j) of the act, effective September 13, 1960,
where any provision of title II, or any provision of another
[[Page 62]]
law of the United States (other than the Internal Revenue Code of 1954)
relating to or changing the effect of title II, or any regulation of the
Commissioner issued under title II, provides for a period within which
an act is required to be done which affects eligibility for or the
amount of any benefit or payment under this title or is necessary to
establish or protect any rights under this title, and such period ends
on a Saturday, Sunday or Federal legal holiday or on any other day all
or part of which is declared to be a nonwork day for Federal employees
by statute or Executive Order, then such act shall be considered as done
within such period if it is done on the first day thereafter which is
not a Saturday, Sunday, or legal holiday or any other day all or part of
which is declared to be a nonwork day for Federal employees either by
statute or Executive Order. For purposes of this paragraph, the day on
which a period ends shall include the final day of any extended period
where such extension is authorized by law or by the Commissioner
pursuant to law. Such extension of any period of limitation does not
apply to periods during which benefits may be paid for months prior to
the month an application for such benefits is filed pursuant to Sec.
404.621, or to periods during which an application for benefits may be
accepted as such pursuant to Sec.404.620.
[26 FR 7055, Aug. 5, 1961, as amended at 29 FR 15509, Nov. 19, 1964; 51
FR 11718, Apr. 7, 1986; 61 FR 41330, Aug. 8, 1996; 62 FR 38450, July 18,
1997]
Subpart B_Insured Status and Quarters of Coverage
Authority: Secs. 205(a), 212, 213, 214, 216, 217, 223, and 702(a)(5)
of the Social Security Act (42 U.S.C. 405(a), 412, 413, 414, 416, 417,
423, and 902(a)(5)).
Source: 45 FR 25384, Apr. 15, 1980, unless otherwise noted.
General
Sec.404.101 Introduction.
(a) Insured status. This subpart explains what we mean when we say
that a person has insured status under the social security program. It
also describes how a person may become fully insured, currently insured
or insured for disability benefits. Your insured status is a basic
factor in determining if you are entitled to old-age or disability
insurance benefits or to a period of disability. It is also a basic
factor in determining if dependents' or survivors' insurance benefits or
a lump-sum death payment are payable based on your earnings record. If
you are neither fully nor currently insured, no benefits are payable
based on your earnings. (Subpart D of this part describes these benefits
and the kind of insured status required for each.) In Sec.Sec.404.110
through 404.120 we tell how we determine if you are fully or currently
insured. The rules for determining if you are insured for purposes of
establishing a period of disability or becoming entitled to disability
insurance benefits are in Sec.Sec.404.130 through 404.133. Whether
you have the required insured status depends on the number of quarters
of coverage (QCs) you have acquired.
(b) QCs. This subpart also sets out our rules on crediting you with
QCs. QCs are used in determining insured status. In general, you are
credited with QCs based on the wages you are paid and the self-
employment income you derive during certain periods. (See subpart K of
this part for a definition of wages and self-employment income.) Our
rules on how and when you acquire a QC are contained in Sec.Sec.
404.140 through 404.146.
Sec.404.102 Definitions.
For the purpose of this subpart--
Act means the Social Security Act, as amended.
Age means how many years old you are. You reach a particular age on
the day before your birthday. For example, if your sixty-second birthday
is on July 1, 1979, you became age 62 on June 30, 1979.
Quarter or calendar quarter means a period of three calendar months
ending March 31, June 30, September 30, or December 31 of any year.
We, our, or us means the Social Security Administration.
You or your means the worker whose insured status is being
considered.
[[Page 63]]
Fully Insured Status
Sec.404.110 How we determine fully insured status.
(a) General. We describe how we determine the number of quarters of
coverage (QCs) you need to be fully insured in paragraphs (b), (c), and
(d) of this section. The table in Sec.404.115 may be used to determine
the number of QCs you need to be fully insured under paragraph (b) of
this section. We consider certain World War II veterans to have died
fully insured (see Sec.404.111). We also consider certain employees of
private nonprofit organizations to be fully insured if they meet special
requirements (see Sec.404.112).
(b) How many QCs you need to be fully insured. (1) You need at least
6 QCs but not more than 40 QCs to be fully insured. A person who died
before 1951 with at least 6 QCs is fully insured.
(2) You are fully insured for old-age insurance benefits if you have
one QC (whenever acquired) for each calendar year elapsing after 1950
or, if later, after the year in which you became age 21, and before the
year you reach retirement age, that is, before--
(i) The year you become age 62, if you are a woman;
(ii) The year you become age 62, if you are a man who becomes age 62
after 1974;
(iii) The year 1975, if you are a man who became age 62 in 1973 or
1974; or
(iv) The year you became age 65, if you are a man who became age 62
before 1973.
(3) A person who is otherwise eligible for survivor's benefits and
who files an application will be entitled to benefits based on your
earnings if you die fully insured. You will be fully insured if you had
one QC (whenever acquired) for each calendar year elapsing after 1950
or, if later, after the year you became age 21, and before the earlier
of the following years:
(i) The year you die; or
(ii) The year you reach retirement age as shown in paragraph (b)(2)
of this section.
(c) How a period of disability affects the number of QCs you need.
In determining the number of elapsed years under paragraph (b) of this
section, we do not count as an elapsed year any year which is wholly or
partly in a period of disability we established for you. For example, if
we established a period of disability for you from December 5, 1975
through January 31, 1977, the three years, 1975, 1976 and 1977, would
not be counted as elapsed years.
(d) How we credit QCs for fully insured status based on your total
wages before 1951--(1) General. For purposes of paragraph (b) of this
section, we may use the following rules in crediting QCs based on your
wages before 1951 instead of the rule in Sec.404.141(b)(1).
(i) We may consider you to have one QC for each $400 of your total
wages before 1951, as defined in paragraph (d)(2) of this section, if
you have at least 7 elapsed years as determined under paragraph (b)(2)
or (b)(3) of this section; and the number of QCs determined under this
paragraph plus the number of QCs credited to you for periods after 1950
make you fully insured.
(ii) If you file an application in June 1992 or later and you are
not entitled to a benefit under Sec.404.380 or section 227 of the Act
in the month the application is made, we may consider you to have at
least one QC before 1951 if you have $400 or more total wages before
1951, as defined in paragraph (d)(2) of this section, provided that the
number of QCs credited to you under this paragraph plus the number of
QCs credited to you for periods after 1950 make you fully insured.
(2) What are total wages before 1951. For purposes of paragraph
(d)(1) of this section, your total wages before 1951 include--
(i) Remuneration credited to you before 1951 on the records of the
Secretary;
(ii) Wages considered paid to you before 1951 under section 217 of
the Act (relating to benefits in case of veterans);
(iii) Compensation under the Railroad Retirement Act of 1937 before
1951 that can be credited to you under title II of the Social Security
Act; and
(iv) Wages considered paid to you before 1951 under section 231 of
the Act (relating to benefits in case of certain persons interned in the
United States during World War II).
(e) When your fully insured status begins. You are fully insured as
of the
[[Page 64]]
first day of the calendar quarter in which you acquire the last needed
QC (see Sec.404.145).
[45 FR 25384, Apr. 15, 1980, as amended at 50 FR 36573, Sept. 9, 1985;
57 FR 23156, June 2, 1992]
Sec.404.111 When we consider a person fully insured based on World
War II active military or naval service.
We consider that a person, who was not otherwise fully insured, died
fully insured if--
(a) The person was in the active military or naval service of the
United States during World War II;
(b) The person died within three years after separation from service
and before July 27, 1954; and
(c) The conditions in Sec.404.1350 that permit us to consider the
person fully insured are met.
(d) The provisions of this section do not apply to persons filing
applications after May 31, 1992, unless a survivor is entitled to
benefits under section 202 of the Act based on the primary insurance
amount of the fully insured person for the month preceding the month in
which the application is made.
[45 FR 25384, Apr. 15, 1980, as amended at 57 FR 23157, June 2, 1992]
Sec.404.112 When we consider certain employees of private nonprofit
organizations to be fully insured.
If you are age 55 or over on January 1, 1984, and are on that date
an employee of an organization described in Sec.404.1025(a) which does
not have in effect a waiver certificate under section 3121(k) of the
Code on that date and whose employees are mandatorily covered as a
result of section 102 of Pub. L. 98-21, we consider you to be fully
insured if you meet the following requirements:
------------------------------------------------------------------------
QC's
acquired
Your age on January 1, 1984 is-- after Dec.
31, 1983
------------------------------------------------------------------------
60 or over................................................. 6
59 or over but less than age 60............................ 8
58 or over but less than age 59............................ 12
57 or over but less than age 58............................ 16
55 or over but less than age 57............................ 20
------------------------------------------------------------------------
[50 FR 36573, Sept. 9, 1985]
Sec.404.115 Table for determining the quarters of coverage you need to be fully insured.
(a) General. You may use the following table to determine the number
of quarters of coverage (QCs) you need to be fully insured under Sec.
404.110. Paragraphs (b) and (c) of this section tell you how to use this
table.
----------------------------------------------------------------------------------------------------------------
Worker who reaches retirement age as described in Sec.404.110(b)(2) Worker who dies before reaching
----------------------------------------------------------------------- retirement age as described in Sec.
Col. II \1\ 404.110(b)(2)
---------------------------------------------------------------------
Col. V \4\--
Col. I--Date of birth Col. III Age in year
Men Women \2\--Year of Col. IV \3\ of death
death
----------------------------------------------------------------------------------------------------------------
Jan. 1, 1893 or earlier................... 6 6 \5\ 1957 6 \6\ 28
Jan. 2, 1893 to Jan. 1, 1894.............. 7 6 1958 7 29
Jan. 2, 1894 to Jan. 1, 1895.............. 8 6 1959 8 30
Jan. 2, 1895 to Jan. 1, 1896.............. 9 6 1960 9 31
Jan. 2, 1896 to Jan. 1, 1897.............. 10 7 1961 10 32
Jan. 2, 1897 to Jan. 1, 1898.............. 11 8 1962 11 33
Jan. 2, 1898 to Jan. 1, 1899.............. 12 9 1963 12 34
Jan. 2, 1899 to Jan. 1, 1900.............. 13 10 1964 13 35
Jan. 2, 1900 to Jan. 1, 1901.............. 14 11 1965 14 36
Jan. 2, 1901 to Jan. 1, 1902.............. 15 12 1966 15 37
Jan. 2, 1902 to Jan. 1, 1903.............. 16 13 1967 16 38
Jan. 2, 1903 to Jan. 1, 1904.............. 17 14 1968 17 39
Jan. 2, 1904 to Jan. 1, 1905.............. 18 15 1969 18 40
Jan. 2, 1905 to Jan. 1, 1906.............. 19 16 1970 19 41
Jan. 2, 1906 to Jan. 1, 1907.............. 20 17 1971 20 42
Jan. 2, 1907 to Jan. 1, 1908.............. 21 18 1972 21 43
Jan. 2, 1908 to Jan. 1, 1909.............. 22 19 1973 22 44
Jan. 2, 1909 to Jan. 1, 1910.............. 23 20 1974 23 45
Jan. 2, 1910 to Jan. 1, 1911.............. 24 21 1975 24 46
Jan. 2, 1911 to Jan. 1, 1912.............. 24 22 1976 25 47
Jan. 2, 1912 to Jan. 1, 1913.............. 24 23 1977 26 48
Jan. 2, 1913 to Jan. 1, 1914.............. 24 24 1978 27 49
Jan. 2, 1914 to Jan. 1, 1915.............. 25 25 1979 28 50
Jan. 2, 1915 to Jan. 1, 1916.............. 26 26 1980 29 51
[[Page 65]]
Jan. 2, 1916 to Jan. 1, 1917.............. 27 27 1981 30 52
Jan. 2, 1917 to Jan. 1, 1918.............. 28 28 1982 31 53
Jan. 2, 1918 to Jan. 1, 1919.............. 29 29 1983 32 54
Jan. 2, 1919 to Jan. 1, 1920.............. 30 30 1984 33 55
Jan. 2, 1920 to Jan. 1, 1921.............. 31 31 1985 34 56
Jan. 2, 1921 to Jan. 1, 1922.............. 32 32 1986 35 57
Jan. 2, 1922 to Jan. 1, 1923.............. 33 33 1987 36 58
Jan. 2, 1923 to Jan. 1, 1924.............. 34 34 1988 37 59
Jan. 2, 1924 to Jan. 1, 1925.............. 35 35 1989 38 60
Jan. 2, 1925 to Jan. 1, 1926.............. 36 36 1990 39 61
Jan. 2, 1926 to Jan. 1, 1927.............. 37 37 \7\ 1991 40 62
Jan. 2, 1927 to Jan. 1, 1928.............. 38 38 ............ ............ ............
Jan. 2, 1928 to Jan. 1, 1929.............. 39 39 ............ ............ ............
Jan. 2, 1929 or later..................... 40 ............ ............ ............
----------------------------------------------------------------------------------------------------------------
\1\ Number of QCs required for fully insured status; living worker or worker who dies after reaching retirement
age.
\2\ Worker born before Jan. 2, 1930 who dies before reaching retirement age.
\3\ Number of QCs required for fully insured status.
\4\ Worker born Jan. 2, 1930 or later, who dies before reaching retirement age.
\5\ Or earlier.
\6\ Or younger.
\7\ Or later.
(b) Number of QCs you need. The QCs you need for fully insured
status are in column II opposite your date of birth in column I. If a
worker dies before reaching retirement age as described in Sec.
404.110(b)(2), the QCs needed for fully insured status are shown in
column IV opposite--
(1) The year of death in column III, if the worker was born before
January 2, 1930; or
(2) The age in the year of death in column V, if the worker was born
after January 1, 1930.
(c) How a period of disability affects the number of QCs you need.
If you had a period of disability established for you, it affects the
number of QCs you need to be fully insured (see Sec.404.110(c)). For
each year which is wholly or partly in a period of disability, subtract
one QC from the number of QCs shown in the appropriate line and column
of the table as explained in paragraph (b) of this section.
Currently Insured Status
Sec.404.120 How we determine currently insured status.
(a) What the period is for determining currently insured status. You
are currently insured if you have at least 6 quarters of coverage (QCs)
during the 13-quarter period ending with the quarter in which you--
(1) Die;
(2) Most recently became entitled to disability insurance benefits;
or
(3) Became entitled to old-age insurance benefits.
(b) What quarters are not counted as part of the 13-quarter period.
We do not count as part of the 13-quarter period any quarter all or part
of which is included in a period of disability established for you,
except that the first and last quarters of the period of disability may
be counted if they are QCs (see Sec.404.146(d)).
Disability Insured Status
Sec.404.130 How we determine disability insured status.
(a) General. We have four different rules for determining if you are
insured for purposes of establishing a period of disability or becoming
entitled to disability insurance benefits. To have disability insured
status, you must meet one of these rules and you must be fully insured
(see Sec.404.132 which tells when the period ends for determining the
number of quarters of coverage (QCs) you need to be fully insured).
(b) Rule I--You must meet the 20/40 requirement. You are insured in
a quarter for purposes of establishing a period of disability or
becoming entitled to disability insurance benefits if in that quarter--
[[Page 66]]
(1) You are fully insured; and
(2) You have at least 20 QCs in the 40-quarter period (see paragraph
(f) of this section) ending with that quarter.
(c) Rule II--You become disabled before age 31. You are insured in a
quarter for purposes of establishing a period of disability or becoming
entitled to disability insurance benefits if in that quarter--
(1) You have not become (or would not become) age 31;
(2) You are fully insured; and
(3) You have QCs in at least one-half of the quarters during the
period ending with that quarter and beginning with the quarter after the
quarter you became age 21; however--
(i) If the number of quarters during this period is an odd number,
we reduce the number by one; and
(ii) If the period has less than 12 quarters, you must have at least
6 QCs in the 12-quarter period ending with that quarter.
(d) Rule III--You had a period of disability before age 31. You are
insured in a quarter for purposes of establishing a period of disability
or becoming entitled to disability insurance benefits if in that
quarter--
(1) You are disabled again at age 31 or later after having had a
prior period of disability established which began before age 31 and for
which you were only insured under paragraph (c) of this section; and
(2) You are fully insured and have QCs in at least one-half the
calendar quarters in the period beginning with the quarter after the
quarter you became age 21 and through the quarter in which the later
period of disability begins, up to a maximum of 20 QCs out of 40
calendar quarters; however--
(i) If the number of quarters during this period is an odd number,
we reduce the number by one;
(ii) If the period has less than 12 quarters, you must have at least
6 QCs in the 12-quarter period ending with that quarter; and
(iii) No monthly benefits may be paid or increased under Rule III
before May 1983.
(e) Rule IV--You are statutorily blind. You are insured in a quarter
for purposes of establishing a period of disability or becoming entitled
to disability insurance benefits if in that quarter--
(1) You are disabled by blindness as defined in Sec.404.1581; and
(2) You are fully insured.
(f) How we determine the 40-quarter or other period. In determining
the 40-quarter period or other period in paragraph (b), (c), or (d) of
this section, we do not count any quarter all or part of which is in a
prior period of disability established for you, unless the quarter is
the first or last quarter of this period and the quarter is a QC.
However, we will count all the quarters in the prior period of
disability established for you if by doing so you would be entitled to
benefits or the amount of the benefit would be larger.
[49 FR 28547, July 13, 1984, as amended at 55 FR 7313, Mar. 1, 1990]
Sec.404.131 When you must have disability insured status.
(a) For a period of disability. To establish a period of disability,
you must have disability insured status in the quarter in which you
become disabled or in a later quarter in which you are disabled.
(b) For disability insurance benefits. (1) To become entitled to
disability insurance benefits, you must have disability insured status
in the first full month that you are disabled as described in Sec.
404.1501(a), or if later--
(i) The 17th month (if you have to serve a waiting period described
in Sec.404.315(d)) before the month in which you file an application
for disability insurance benefits; or
(ii) The 12th month (if you do not have to serve a waiting period)
before the month in which you file an application for disability
insurance benefits.
(2) If you do not have disability insured status in a month
specified in paragraph (b)(1) of this section, you will be insured for
disability insurance benefits beginning with the first month after that
month in which you do meet the insured status requirement and you also
meet all other requirements for disability insurance benefits described
in Sec.404.315.
[[Page 67]]
Sec.404.132 How we determine fully insured status for a period of
disability or disability insurance benefits.
In determining if you are fully insured for purposes of paragraph
(b), (c), (d), or (e) of Sec.404.130 on disability insured status, we
use the fully insured status requirements in Sec.404.110, but apply
the following rules in determining when the period of elapsed years
ends:
(a) If you are a woman, or a man born after January 1, 1913, the
period of elapsed years in Sec.404.110(b) used in determining the
number of quarters of coverage (QCs) you need to be fully insured ends
as of the earlier of--
(1) The year you become age 62; or
(2) The year in which--
(i) Your period of disability begins;
(ii) Your waiting period begins (see Sec.404.315(d)); or
(iii) You become entitled to disability insurance benefits (if you
do not have to serve a waiting period).
(b) If you are a man born before January 2, 1913, the period of
elapsed years in Sec.404.110(b) used in determining the number of QCs
you need to be fully insured ends as of the earlier of--
(1) The year 1975; or
(2) The year specified in paragraph (a)(2) of this section.
[45 FR 25384, Apr. 15, 1980, as amended at 49 FR 28547, July 13, 1984]
Sec.404.133 When we give you quarters of coverage based on military
service to establish a period of disability.
For purposes of establishing a period of disability only, we give
you quarters of coverage (QCs) for your military service before 1957
(see subpart N of this part). We do this even though we may not use that
military service for other purposes of title II of the Act because a
periodic benefit is payable from another Federal agency based in whole
or in part on the same period of military service.
Quarters of Coverage
Sec.404.140 What is a quarter of coverage.
(a) General. A quarter of coverage (QC) is the basic unit of social
security coverage used in determining a worker's insured status. We
credit you with QCs based on your earnings covered under social
security.
(b) How we credit QCs based on earnings before 1978 (General).
Before 1978, wages were generally reported on a quarterly basis and
self-employment income was reported on an annual basis. For the most
part, we credit QCs for calendar years before 1978 based on your
quarterly earnings. For these years, as explained in Sec.404.141, we
generally credit you with a QC for each calendar quarter in which you
were paid at least $50 in wages or were credited with at least $100 of
self-employment income. Section 404.142 tells how self-employment income
derived in a taxable year beginning before 1978 is credited to specific
calendar quarters for purposes of Sec.404.141.
(c) How we credit QCs based on earnings after 1977 (General). After
1977, both wages and self-employment income are generally reported on an
annual basis. For calendar years after 1977, as explained in Sec.
404.143, we generally credit you with a QC for each part of your total
covered earnings in a calendar year that equals the amount required for
a QC in that year. Section 404.143 also tells how the amount required
for a QC will be increased in the future as average wages increase.
Section 404.144 tells how self-employment income derived in a taxable
year beginning after 1977 is credited to specific calendar years for
purposes of Sec.404.143.
(d) When a QC is acquired and when a calendar quarter is not a QC
(general). Section 404.145 tells when a QC is acquired and Sec.404.146
tells when a calendar quarter cannot be a QC. These rules apply when we
credit QCs under Sec.404.141 or Sec.404.143.
Sec.404.141 How we credit quarters of coverage for calendar years
before 1978.
(a) General. The rules in this section tell how we credit calendar
quarters as quarters of coverage (QCs) for calendar years before 1978.
We credit you with a QC for a calendar quarter based on the amount of
wages you were paid and self-employment income you derived during
certain periods. The rules in paragraphs (b), (c), and (d) of this
section are subject to the limitations in
[[Page 68]]
Sec.404.146, which tells when a calendar quarter cannot be a QC.
(b) How we credit QCs based on wages paid in, or self-employment
income credited to, a calendar quarter. We credit you with a QC for a
calendar quarter in which--
(1) You were paid wages of $50 or more (see paragraph (c) of this
section for an exception relating to wages paid for agricultural labor);
or
(2) You were credited (under Sec.404.142) with self-employment
income of $100 or more.
(c) How we credit QCs based on wages paid for agricultural labor in
a calendar year after 1954. (1) We credit QCs based on wages for
agricultural labor depending on the amount of wages paid during a
calendar year for that work. If you were paid wages for agricultural
labor in a calendar year after 1954 and before 1978, we credit you with
QCs for calendar quarters in that year which are not otherwise QCs
according to the following table.
------------------------------------------------------------------------
If the wages paid to you in a
calendar year for agricultural We credit you with And assign: \1\
labor were
------------------------------------------------------------------------
$400 or more.................... 4 QCs............. All.
At least $300 but less than $400 3 QCs............. Last 3.
At least $200 but less than $300 2 QCs............. Last 2.
At least $100 but less than $200 1 QC.............. Last.
Less than $100.................. No QCs............
------------------------------------------------------------------------
\1\ One QC to each of the following calendar quarters in that year.
(2) When we assign QCs to calendar quarters in a year as shown in
the table in paragraph (c)(1) of this section, you might not meet (or
might not meet as early in the year as otherwise possible) the
requirements to be fully or currently insured, to be entitled to a
computation or recomputation of your primary insurance amount, or to
establish a period of disability. If this happens, we assign the QCs to
different quarters in that year than those shown in the table if this
assignment permits you to meet these requirements (or meet them earlier
in the year). We can only reassign QCs for purposes of meeting these
requirements.
(d) How we credit QCs based on wages paid or self-employment income
derived in a year. (1) If you were paid wages in a calendar year after
1950 and before 1978 at least equal to the annual wage limitation in
effect for that year as described in Sec.Sec.404.1047 and 404.1096,
we credit you with a QC for each quarter in that calendar year. If you
were paid at least $3,000 wages in a calendar year before 1951, we
credit you with a QC for each quarter in that calendar year.
(2) If you derived self-employment income (or derived self-
employment income and also were paid wages) during a taxable year
beginning after 1950 and before 1978 at least equal to the self-
employment income and wage limitation in effect for that year as
described in Sec.404.1068(b), we credit you with a QC for each
calendar quarter wholly or partly in that taxable year.
[45 FR 25384, Apr. 15, 1980; 45 FR 41931, June 23, 1980, as amended at
70 FR 14977, Mar. 24, 2005]
Sec.404.142 How we credit self-employment income to calendar quarters
for taxable years beginning before 1978.
In crediting quarters of coverage under Sec.404.141(b)(2), we
credit any self-employment income you derived during a taxable year that
began before 1978 to calendar quarters as follows:
(a) If your taxable year was a calendar year, we credit your self-
employment income equally to each quarter of that calendar year.
(b) If your taxable year was not a calendar year (that is, it began
on a date other than January 1, or was less than a calendar year), we
credit your self-employment income equally--
(1) To the calendar quarter in which your taxable year ended; and
(2) To each of the next three or fewer preceding quarters that were
wholly or partly in your taxable year.
Sec.404.143 How we credit quarters of coverage for calendar years
after 1977.
(a) Crediting quarters of coverage (QCs). For calendar years after
1977, we credit you with a QC for each part of the total wages paid and
self-employment income credited (under Sec.404.144) to you in a
calendar year that equals the amount required for a QC in that year. For
example, if the total of your wages and self-employment income for a
calendar year is more than twice, but
[[Page 69]]
less than 3 times, the amount required for a QC in that year, we credit
you with only 2 QCs for the year. The rules for crediting QCs in this
section are subject to the limitations in Sec.404.146, which tells
when a calendar quarter cannot be a QC. In addition, we cannot credit
you with more than four QCs for any calendar year. The amount of wages
and self-employment income that you must have for each QC is--
(1) $250 for calendar year 1978; and
(2) For each calendar year after 1978, an amount determined by the
Commissioner for that year (on the basis of a formula in section
213(d)(2) of the Act which reflects national increases in average
wages). The amount determined by the Commissioner is published in the
Federal Register on or before November 1 of the preceding year and
included in the appendix to this subpart.
(b) Assigning QCs. We assign a QC credited under paragraph (a) of
this section to a specific calendar quarter in the calendar year only if
the assignment is necessary to--
(1) Give you fully or currently insured status;
(2) Entitle you to a computation or recomputation of your primary
insurance amount; or
(3) Permit you to establish a period of disability.
[45 FR 25834, Apr. 15, 1980, as amended at 62 FR 38450, July 18, 1997]
Sec.404.144 How we credit self-employment income to calendar years
for taxable years beginning after 1977.
In crediting quarters of coverage under Sec.404.143(a), we credit
self-employment income you derived during a taxable year that begins
after 1977 to calendar years as follows:
(a) If your taxable year is a calendar year or begins and ends
within the same calendar year, we credit your self-employment income to
that calendar year.
(b) If your taxable year begins in one calendar year and ends in the
following calendar year, we allocate proportionately your self-
employment income to the two calendar years on the basis of the number
of months in each calendar year which are included completely within
your taxable year. We consider the calendar month in which your taxable
year ends as included completely within your taxable year.
Example: For the taxable year beginning May 15, 1978, and ending May
14, 1979, your self-employment income is $1200. We credit 7/12 ($700) of
your self-employment income to calendar year 1978 and 5/12 ($500) of
your self-employment income to calendar year 1979.
Sec.404.145 When you acquire a quarter of coverage.
If we credit you with a quarter of coverage (QC) for a calendar
quarter under paragraph (b), (c), or (d) of Sec.404.141 for calendar
years before 1978 or assign it to a specific calendar quarter under
paragraph (b) of Sec.404.143 for calendar years after 1977, you
acquire the QC as of the first day of the calendar quarter.
Sec.404.146 When a calendar quarter cannot be a quarter of coverage.
This section applies when we credit you with quarters of coverage
(QCs) under Sec.404.141 for calendar years before 1978 and under Sec.
404.143 for calendar years after 1977. We cannot credit you with a QC
for--
(a) A calendar quarter that has not begun;
(b) A calendar quarter that begins after the quarter of your death;
(c) A calendar quarter that has already been counted as a QC; or
(d) A calendar quarter that is included in a period of disability
established for you, unless--
(1) The quarter is the first or the last quarter of this period; or
(2) The period of disability is not taken into consideration (see
Sec.404.320(a)).
Appendix to Subpart B of Part 404--Quarter of Coverage Amounts for
Calendar Years After 1978
This appendix shows the amount determined by the Commissioner that
is needed for a quarter of coverage for each year after 1978 as
explained in Sec.404.143. We publish the amount as a Notice in the
Federal Register on or before November 1 of the preceding year. The
amounts determined by the Commissioner are as follows:
------------------------------------------------------------------------
Amount
Calendar year needed
------------------------------------------------------------------------
1979.......................................................... $260
1980.......................................................... 290
1981.......................................................... 310
[[Page 70]]
1982.......................................................... 340
1983.......................................................... 370
1984.......................................................... 390
1985.......................................................... 410
1986.......................................................... 440
1987.......................................................... 460
1988.......................................................... 470
1989.......................................................... 500
1990.......................................................... 520
1991.......................................................... 540
1992.......................................................... 570
------------------------------------------------------------------------
[45 FR 25384, Apr. 15, 1980, as amended at 52 FR 8247, Mar. 17, 1987; 57
FR 44096, Sept 24, 1992; 62 FR 38450, July 18, 1997]
Subpart C_Computing Primary Insurance Amounts
Authority: Secs. 202(a), 205(a), 215, and 702(a)(5) of the Social
Security Act (42 U.S.C. 402(a), 405(a), 415, and 902(a)(5)).
Source: 47 FR 30734, July 15, 1982, unless otherwise noted.
General
Sec.404.201 What is included in this subpart?
In this subpart we describe how we compute your primary insurance
amount (PIA), how and when we will recalculate or recompute your PIA to
include credit for additional earnings, and how we automatically adjust
your PIA to reflect changes in the cost of living.
(a) What is my primary insurance amount? Your primary insurance
amount (PIA) is the basic figure we use to determine the monthly benefit
amount payable to you and your family. For example, if you retire in the
month you attain full retirement age (as defined in Sec.404.409) or if
you become disabled, you will be entitled to a monthly benefit equal to
your PIA. If you retire prior to full retirement age your monthly
benefit will be reduced as explained in Sec.Sec.404.410-404.413.
Benefits to other members of your family are a specified percentage of
your PIA as explained in subpart D. Total benefits to your family are
subject to a maximum as explained in Sec.404.403.
(b) How is this subpart organized? (1) In Sec.Sec.404.201 through
404.204, we explain some introductory matters.
(2) In Sec.Sec.404.210 through 404.213, we describe the average-
indexed-monthly-earnings method we use to compute the primary insurance
amount (PIA) for workers who attain age 62 (or become disabled or die
before age 62) after 1978.
(3) In Sec.Sec.404.220 through 404.222, we describe the average-
monthly-wage method we use to compute the PIA for workers who attain age
62 (or become disabled or die before age 62) before 1979.
(4) In Sec.Sec.404.230 through 404.233, we describe the
guaranteed alternative method we use to compute the PIA for people who
attain age 62 after 1978 but before 1984.
(5) In Sec.Sec.404.240 through 404.243, we describe the old-start
method we use to compute the PIA for those who had all or substantially
all of their social security covered earnings before 1951.
(6) In Sec.Sec.404.250 through 404.252, we describe special rules
we use to compute the PIA for a worker who previously had a period of
disability.
(7) In Sec.Sec.404.260 through 404.261, we describe how we
compute the special minimum PIA for long-term, low-paid workers.
(8) In Sec.Sec.404.270 through 404.278, we describe how we
automatically increase your PIA because of increases in the cost of
living.
(9) In Sec.Sec.404.280 through 404.288, we describe how and when
we will recompute your PIA to include additional earnings which were not
used in the original computation.
(10) In Sec.404.290 we describe how and when we will recalculate
your PIA.
(11) Appendices I-VII contain material such as figures and formulas
that we use to compute PIAs.
[68 FR 4701, Jan. 30, 2003]
Sec.404.202 Other regulations related to this subpart.
This subpart is related to several others. In subpart B of this
part, we describe how you become insured for social security benefits as
a result of your work in covered employment. In subpart D, we discuss
the different kinds of social security benefits available--old-age and
disability benefits for you and benefits for your dependents and
survivors--the amount of the benefits, and the requirements you and
[[Page 71]]
your family must meet to qualify for them; your work status, your age,
the size of your family, and other factors may affect the amount of the
benefits for you and your family. Rules relating to deductions,
reductions, and nonpayment of benefits we describe in subpart E. In
subpart F of this part, we describe what we do when a recalculation or
recomputation of your primary insurance amount (as described in this
subpart) results in our finding that you and your family have been
overpaid or underpaid. In subparts G and H of this part, we tell how to
apply for benefits and what evidence is needed to establish entitlement
to them. In subpart J of this part, we describe how benefits are paid.
Then in subparts I, K, N, and O of this part, we discuss your earnings
that are taxable and creditable for social security purposes (and how we
keep records of them), and deemed military wage credits which may be
used in finding your primary insurance amount.
Sec.404.203 Definitions.
(a) General definitions. As used in this subpart--
Ad hoc increase in primary insurance amounts means an increase in
primary insurance amounts enacted by the Congress and signed into law by
the President.
Entitled means that a person has applied for benefits and has proven
his or her right to them for a given period of time.
We, us, or our means the Social Security Administration.
You or your means the insured worker who has applied for benefits or
a deceased insured worker on whose social security earnings record
someone else has applied.
(b) Other definitions. To make it easier to find them, we have
placed other definitions in the sections of this subpart in which they
are used.
[47 FR 30734, July 15, 1982, as amended at 62 FR 38450, July 18, 1997]
Sec.404.204 Methods of computing primary insurance amounts--general.
(a) General. We compute most workers' primary insurance amounts
under one of two major methods. There are, in addition, several special
methods of computing primary insurance amounts which we apply to some
workers. Your primary insurance amount is the highest of all those
computed under the methods for which you are eligible.
(b) Major methods. (1) If after 1978 you reach age 62, or become
disabled or die before age 62, we compute your primary insurance amount
under what we call the average-indexed-monthly-earnings method, which is
described in Sec.Sec.404.210 through 404.212. The earliest of the
three dates determines the computation method we use.
(2) If before 1979 you reached age 62, became disabled, or died, we
compute your primary insurance amount under what we call the average-
monthly-wage method, described in Sec.Sec.404.220 through 404.222.
(c) Special methods. (1) Your primary insurance amount, computed
under any of the special methods for which you are eligible as described
in this paragraph, may be substituted for your primary insurance amount
computed under either major method described in paragraph (b) of this
section.
(2) If you reach age 62 during the period 1979-1983, your primary
insurance amount is guaranteed to be the highest of--
(i) The primary insurance amount we compute for you under the
average-indexed-monthly-earnings method;
(ii) The primary insurance amount we compute for you under the
average-monthly-wage method, as modified by the rules described in
Sec.Sec.404.230 through 404.233; or
(iii) The primary insurance amount computed under what we call the
old-start method; as described in Sec.Sec.404.240 through 404.242.
(3) If you had all or substantially all of your social security
earnings before 1951, we will also compute your primary insurance amount
under what we call the old-start method.
(4) We compute your primary insurance amount under the rules in
Sec.Sec.404.250 through 404.252, if--
(i) You were disabled and received social security disability
insurance benefits sometime in your life;
(ii) Your disability insurance benefits were terminated because of
your recovery or because you engaged in substantial gainful activity;
and
[[Page 72]]
(iii) You are, after 1978, re-entitled to disability insurance
benefits, or entitled to old-age insurance benefits, or have died.
(5) In some situations, we use what we call a special minimum
computation, described in Sec.Sec.404.260 through 404.261, to find
your primary insurance amount. Computations under this method reflect
long-term, low-wage attachment to covered work.
Average-Indexed-Monthly-Earnings Method of Computing Primary Insurance
Amounts
Sec.404.210 Average-indexed-monthly-earnings method.
(a) Who is eligible for this method. If after 1978, you reach age
62, or become disabled or die before age 62, we will compute your
primary insurance amount under the average-indexed-monthly-earnings
method.
(b) Steps in computing your primary insurance amount under the
average-indexed-monthly-earnings method. We follow these three major
steps in computing your primary insurance amount:
(1) First, we find your average indexed monthly earnings, as
described in Sec.404.211;
(2) Second, we find the benefit formula in effect for the year you
reach age 62, or become disabled or die before age 62, as described in
Sec.404.212; and
(3) Then, we apply that benefit formula to your average indexed
monthly earnings to find your primary insurance amount, as described in
Sec.404.212.
(4) Next, we apply any automatic cost-of-living or ad hoc increases
in primary insurance amounts that became effective in or after the year
you reached age 62, unless you are receiving benefits based on the
minimum primary insurance amount, in which case not all the increases
may be applied, as described in Sec.404.277.
Sec.404.211 Computing your average indexed monthly earnings.
(a) General. In this method, your social security earnings after
1950 are indexed, as described in paragraph (d) of this section, then
averaged over the period of time you can reasonably have been expected
to have worked in employment or self-employment covered by social
security. (Your earnings before 1951 are not used in finding your
average indexed monthly earnings.)
(b) Which earnings may be used in computing your average indexed
monthly earnings--(1) Earnings. In computing your average indexed
monthly earnings, we use wages, compensation, self-employment income,
and deemed military wage credits (see Sec.Sec.404.1340 through
404.1343) that are creditable to you for social security purposes for
years after 1950.
(2) Computation base years. We use your earnings in your computation
base years in finding your average indexed monthly earnings. All years
after 1950 up to (but not including) the year you become entitled to
old-age or disability insurance benefits, and through the year you die
if you had not been entitled to old-age or disability benefits, are
computation base years for you. The year you become entitled to benefits
and following years may be used as computation base years in a
recomputation if their use would result in a higher primary insurance
amount. (See Sec.Sec.404.280 through 404.287.) However, years after
the year you die may not be used as computation base years even if you
have earnings credited to you in those years. Computation base years do
not include years wholly within a period of disability unless your
primary insurance amount would be higher by using the disability years.
In such situations, we count all the years during the period of
disability, even if you had no earnings in some of them.
(c) Average of the total wages. Before we compute your average
indexed monthly earnings, we must first know the ``average of the total
wages'' of all workers for each year from 1951 until the second year
before you become eligible. The average of the total wages for years
after 1950 are shown in appendix I. Corresponding figures for more
recent years which have not yet been incorporated into this appendix are
published in the Federal Register on or before November 1 of the
succeeding year. ``Average of the total wages'' (or ``average wage'')
means:
(1) For the years 1951 through 1977, four times the amount of
average taxable wages that were reported to the
[[Page 73]]
Social Security Administration for the first calendar quarter of each
year for social security tax purposes. For years prior to 1973, these
average wages were determined from a sampling of these reports.
(2) For the years 1978 through 1990, all remuneration reported as
wages on Form W-2 to the Internal Revenue Service for all employees for
income tax purposes, divided by the number of wage earners. We adjusted
those averages to make them comparable to the averages for 1951-1977.
For years after 1977, the term includes remuneration for services not
covered by social security and remuneration for covered employment in
excess of that which is subject to FICA contributions.
(3) For years after 1990, all remuneration reported as wages on Form
W-2 to the Internal Revenue Service for all employees for income tax
purposes, including remuneration described in paragraph (c)(2) of this
section, plus contributions to certain deferred compensation plans
described in section 209(k) of the Social Security Act (also reported on
Form W-2), divided by the number of wage earners. If both distributions
from and contributions to any such deferred compensation plan are
reported on Form W-2, we will include only the contributions in the
calculation of the average of the total wages. We will adjust those
averages to make them comparable to the averages for 1951-1990.
(d) Indexing your earnings. (1) The first step in indexing your
social security earnings is to find the relationship (under paragraph
(d)(2) of this section) between--
(i) The average wage of all workers in your computation base years;
and
(ii) The average wage of all workers in your indexing year. As a
general rule, your indexing year is the second year before the earliest
of the year you reach age 62, or become disabled or die before age 62.
However, your indexing year is determined under paragraph (d)(4) of this
section if you die before age 62, your surviving spouse or surviving
divorced spouse is first eligible for benefits after 1984, and the
indexing year explained in paragraph (d)(4) results in a higher
widow(er)'s benefit than results from determining the indexing year
under the general rule.
(2) To find the relationship, we divide the average wages for your
indexing year, in turn, by the average wages for each year beginning
with 1951 and ending with your indexing year. We use the quotients found
in these divisions to index your earnings as described in paragraph
(d)(3) of this section.
(3) The second step in indexing your social security earnings is to
multiply the actual year-by-year dollar amounts of your earnings (up to
the maximum amounts creditable, as explained in Sec.Sec.404.1047 and
404.1096 of this part) by the quotients found in paragraph (d)(2) of
this section for each of those years. We round the results to the nearer
penny. (The quotient for your indexing year is 1.0; this means that your
earnings in that year are used in their actual dollar amount; any
earnings after your indexing year that may be used in computing your
average indexed monthly earnings are also used in their actual dollar
amount.)
Example: Ms. A reaches age 62 in July 1979. Her year-by-year social
security earnings since 1950 are as follows:
------------------------------------------------------------------------
Year Earnings
------------------------------------------------------------------------
1951....................................................... $3,200
1952....................................................... 3,400
1953....................................................... 3,300
1954....................................................... 3,600
1955....................................................... 3,700
1956....................................................... 3,700
1957....................................................... 4,000
1958....................................................... 4,200
1959....................................................... 4,400
1960....................................................... 4,500
1961....................................................... 2,800
1962....................................................... 2,200
1963....................................................... 0
1964....................................................... 0
1965....................................................... 3,700
1966....................................................... 4,500
1967....................................................... 5,400
1968....................................................... 6,200
1969....................................................... 6,900
1970....................................................... 7,300
1971....................................................... 7,500
1972....................................................... 7,800
1973....................................................... 8,200
1974....................................................... 9,000
1975....................................................... 9,900
1976....................................................... 11,100
1977....................................................... 9,900
1978....................................................... 11,000
------------------------------------------------------------------------
Step 1. The first step in indexing Ms. A's earnings is to find the
relationship between the general wage level in Ms. A's indexing year
(1977) and the general wage level in each of the years 1951-1976. We
refer to appendix I
[[Page 74]]
for average wage figures, and perform the following computations:
------------------------------------------------------------------------
II. III. Column
I. 1977 Nationwide I divided by
Year general average of column II
wage level the total equals
wages relationship
------------------------------------------------------------------------
1951.............................. $9,779.44 $2,799.16 3.4937053
1952........................