SSR 16-2p: Rescinded

SSR 16-2p: Rescinded and replaced by SSR

22-2p effective May 17, 2022

Effective Date: March 14, 2016 Federal Register Vol. 81,

No. 49, page 13440

POLICY INTERPRETATION RULING

Social Security Ruling

This SSR rescinds and replaces SSR 00-2p : “TITLES II AND XVI:

EVALUATION OF CLAIMS INVOLVING THE ISSUE OF “SIMILAR FAULT”

IN THE PROVIDING OF EVIDENCE.”

PURPOSE: To explain the rules that govern the evaluation and

adjudication of claims when there is reason to believe similar fault

was involved in the providing of evidence in support of the claim.

CITATIONS: Sections 205(u) and 1631(e)(7) of the Social Security Act,

42 U.S.C. 405(u), 1383(e)(7), as amended; 20 CFR 404.704, 404.708 , 404.1512 , 404.1520 , 416.912 , 416.920 , 416.924 , and 422.130(b) .

INTRODUCTION:

The Social Security Independence and Program Improvements Act of

1994, Public Law 103-296, amended the Social Security Act (Act) to add

provisions addressing fraud or similar fault. These amendments to sections 205 and 1631 of the

Act provide that we must immediately redetermine

an individual's entitlement to monthly insurance benefits under title

II or eligibility for benefits under title XVI if there is reason to

believe that fraud or similar fault was involved in the individual's

application for such benefits. This statute further provides that, when

we redetermine entitlement or eligibility, or when we make an initial

determination of entitlement or eligibility, we "shall disregard any

evidence if there is reason to believe that fraud or similar fault was

involved in the providing of such evidence." If, after redetermining

entitlement to or eligibility for benefits, we determine that without

the disregarded evidence, the evidence does not support entitlement or

eligibility, we may terminate such entitlement or eligibility and may

treat benefits paid based on such evidence as overpayments.

re is reason to believe that fraud or similar fault was

involved in the providing of such evidence." If, after redetermining

entitlement to or eligibility for benefits, we determine that without

the disregarded evidence, the evidence does not support entitlement or

eligibility, we may terminate such entitlement or eligibility and may

treat benefits paid based on such evidence as overpayments.

This Ruling sets forth the standards we and State agency adjudicators

will apply at all levels of the administrative review process in

determining whether there is reason to believe that similar fault was

involved in providing evidence in connection with a claim for benefits. It

also provides guidance for the evaluation of such claims when there

is reason to believe that similar fault was involved. It applies to

all claims for benefits under title II and title XVI of the Act; e.g.,

claims for old-age and survivors benefits and disability benefits under

title II of the Act, and claims for Supplemental Security Income benefits

for the aged, blind, and disabled under title XVI of the Act.

This Ruling does not replace or limit other appropriate standards and

criteria for development and evaluation of claims. There may be instances

in which evidence will not be disregarded under the statutory provisions

discussed in this Ruling, but nevertheless, factors may exist that

justify giving the evidence in question less credence than other evidence.

POLICY INTERPRETATION:

A. General

- Sections 205(u) and 1631(e)(7) of the Act provide that we must

disregard evidence if there is reason to believe that fraud or similar

fault was involved in the providing of that evidence. These sections

explain that similar fault is involved if: “(A) an incorrect or

incomplete statement that is material to the determination is knowingly made;

or (B) information that is material to the determination is knowingly

concealed.”

he Act provide that we must

disregard evidence if there is reason to believe that fraud or similar

fault was involved in the providing of that evidence. These sections

explain that similar fault is involved if: “(A) an incorrect or

incomplete statement that is material to the determination is knowingly made;

or (B) information that is material to the determination is knowingly

concealed.”

- We may find that any individual or entity whose actions affect an

individual's application for monthly benefits, has committed fraud or

similar fault. We may disregard evidence based on similar fault of a

claimant, a recipient of benefits, or any other individual or entity

connected with the claim. Examples of any individual or entity include

a claimant, beneficiary, auxiliary, recipient, spouse, representative,

medical source, translator, interpreter, and representative payee. Sections 205(u) or 1631(e)(7) of the Act do not require that the

individual or entity who committed fraud or similar fault, or the

individual or entity providing the evidence that involves fraud or similar

fault, have a direct relationship to or act on behalf of the claimant,

beneficiary, or recipient, or directly or indirectly benefit from the

fraud or similar fault.

- A finding of similar fault can be made only if there is reason

to believe that, based on a preponderance of the evidence, the person

committing the fault knew that the evidence provided was false or incomplete.

We cannot base a finding of similar fault on speculation or suspicion.

- A finding of similar fault is sufficient to take the administrative

actions described in this Ruling. Although a finding of "fraud" made as

part of a criminal prosecution can serve as a basis for the administrative

actions described below, such a finding is not required.

hat the evidence provided was false or incomplete.

We cannot base a finding of similar fault on speculation or suspicion.

- A finding of similar fault is sufficient to take the administrative

actions described in this Ruling. Although a finding of "fraud" made as

part of a criminal prosecution can serve as a basis for the administrative

actions described below, such a finding is not required.

- A finding of similar fault concerning a material fact may constitute

evidence to be considered in determining whether there is reason to

believe that similar fault was involved with respect to other evidence

provided by the same source, and may justify disregarding other evidence

from that source. Also, the evidence relied on to make a finding of

similar fault in one claim may be considered in deciding whether there

is similar fault in another claim or in deciding whether to give less

weight to evidence in another claim.

- A finding of similar fault does not constitute complete adjudicative

action in any claim. A person may still be found entitled to, or eligible

for, monthly benefits despite the fact that some evidence in the case

record has been disregarded based on similar fault.

Sections 205(u) and 1631(e)(7) of the Act provide that we must

disregard evidence if there is reason to believe that fraud or similar

fault was involved in the providing of that evidence. These sections

explain that similar fault is involved if: “(A) an incorrect or

incomplete statement that is material to the determination is knowingly made;

or (B) information that is material to the determination is knowingly

concealed.”

he Act provide that we must

disregard evidence if there is reason to believe that fraud or similar

fault was involved in the providing of that evidence. These sections

explain that similar fault is involved if: “(A) an incorrect or

incomplete statement that is material to the determination is knowingly made;

or (B) information that is material to the determination is knowingly

concealed.”

We may find that any individual or entity whose actions affect an

individual's application for monthly benefits, has committed fraud or

similar fault. We may disregard evidence based on similar fault of a

claimant, a recipient of benefits, or any other individual or entity

connected with the claim. Examples of any individual or entity include

a claimant, beneficiary, auxiliary, recipient, spouse, representative,

medical source, translator, interpreter, and representative payee. Sections 205(u) or 1631(e)(7) of the Act do not require that the

individual or entity who committed fraud or similar fault, or the

individual or entity providing the evidence that involves fraud or similar

fault, have a direct relationship to or act on behalf of the claimant,

beneficiary, or recipient, or directly or indirectly benefit from the

fraud or similar fault.

A finding of similar fault can be made only if there is reason

to believe that, based on a preponderance of the evidence, the person

committing the fault knew that the evidence provided was false or incomplete.

We cannot base a finding of similar fault on speculation or suspicion.

A finding of similar fault is sufficient to take the administrative

actions described in this Ruling. Although a finding of "fraud" made as

part of a criminal prosecution can serve as a basis for the administrative

actions described below, such a finding is not required.

that the evidence provided was false or incomplete.

We cannot base a finding of similar fault on speculation or suspicion.

A finding of similar fault is sufficient to take the administrative

actions described in this Ruling. Although a finding of "fraud" made as

part of a criminal prosecution can serve as a basis for the administrative

actions described below, such a finding is not required.

A finding of similar fault concerning a material fact may constitute

evidence to be considered in determining whether there is reason to

believe that similar fault was involved with respect to other evidence

provided by the same source, and may justify disregarding other evidence

from that source. Also, the evidence relied on to make a finding of

similar fault in one claim may be considered in deciding whether there

is similar fault in another claim or in deciding whether to give less

weight to evidence in another claim.

A finding of similar fault does not constitute complete adjudicative

action in any claim. A person may still be found entitled to, or eligible

for, monthly benefits despite the fact that some evidence in the case

record has been disregarded based on similar fault.

B. Definitions

- Fraud. Fraud exists when a person, with the intent to defraud,

either makes or causes to be made, a false statement or misrepresentation of a

material fact for use in determining rights under the Social Security Act;

or conceals or fails to disclose a material fact for use in determining

rights under the Social Security Act.

- Similar Fault. As defined in section 205(u)(2) and 1631(e)(7)(B) of the Act, similar fault is involved with respect to a determination

if: “(A) an incorrect or incomplete statement that is material to the

determination is knowingly made; or (B) information that is material to

the determination is knowingly concealed.”

aterial fact for use in determining

rights under the Social Security Act.

- Similar Fault. As defined in section 205(u)(2) and 1631(e)(7)(B) of the Act, similar fault is involved with respect to a determination

if: “(A) an incorrect or incomplete statement that is material to the

determination is knowingly made; or (B) information that is material to

the determination is knowingly concealed.”

- Material. This term describes a statement or information,

or an omission from a statement or information that could influence us in

determining entitlement to benefits under title II or eligibility for

benefits under title XVI of the Act.

- Knowingly. This term describes a person's awareness or

understanding regarding the correctness or completeness of the information

he or she provides us, or the materiality of the information he or she

conceals from us.

- Preponderance of Evidence. This term means such relevant evidence

that as a whole shows that the existence of a fact to be proven is more

likely than not. Preponderance is established by that piece or body

of evidence that, when considered, produces the stronger impression and

is more convincing as to its truth when weighed against the evidence in

opposition. Thus, preponderance does not require that a certain number of

pieces of evidence (e.g., five or six) must be present. It is possible

that just one piece of evidence may be so convincing that it outweighs

more than one piece of evidence in opposition.

Fraud. Fraud exists when a person, with the intent to defraud,

either makes or causes to be made, a false statement or misrepresentation of a

material fact for use in determining rights under the Social Security Act;

or conceals or fails to disclose a material fact for use in determining

rights under the Social Security Act.

g that it outweighs

more than one piece of evidence in opposition.

Fraud. Fraud exists when a person, with the intent to defraud,

either makes or causes to be made, a false statement or misrepresentation of a

material fact for use in determining rights under the Social Security Act;

or conceals or fails to disclose a material fact for use in determining

rights under the Social Security Act.

Similar Fault. As defined in section 205(u)(2) and 1631(e)(7)(B) of the Act, similar fault is involved with respect to a determination

if: “(A) an incorrect or incomplete statement that is material to the

determination is knowingly made; or (B) information that is material to

the determination is knowingly concealed.”

Material. This term describes a statement or information,

or an omission from a statement or information that could influence us in

determining entitlement to benefits under title II or eligibility for

benefits under title XVI of the Act.

Knowingly. This term describes a person's awareness or

understanding regarding the correctness or completeness of the information

he or she provides us, or the materiality of the information he or she

conceals from us.

Preponderance of Evidence. This term means such relevant evidence

that as a whole shows that the existence of a fact to be proven is more

likely than not. Preponderance is established by that piece or body

of evidence that, when considered, produces the stronger impression and

is more convincing as to its truth when weighed against the evidence in

opposition. Thus, preponderance does not require that a certain number of

pieces of evidence (e.g., five or six) must be present. It is possible

that just one piece of evidence may be so convincing that it outweighs

more than one piece of evidence in opposition.

C. Development and Evaluation

s the stronger impression and

is more convincing as to its truth when weighed against the evidence in

opposition. Thus, preponderance does not require that a certain number of

pieces of evidence (e.g., five or six) must be present. It is possible

that just one piece of evidence may be so convincing that it outweighs

more than one piece of evidence in opposition.

C. Development and Evaluation

Adjudicators at all levels of the administrative review process are

responsible for taking all appropriate steps to resolve similar fault

issues in accordance with the standards in this Ruling. Adjudicators

must adhere to existing due process and confidentiality requirements

during the process of resolving similar fault issues.

In making determinations about whether there is similar fault, all

adjudicators must:

- Consider all evidence in the case record before determining whether

specific evidence may be disregarded.

- Apply the preponderance of evidence standard, as defined in this

Ruling.

- Fully document the record with the evidence that was the basis for the

finding that, based on a preponderance of the evidence, there is reason

to believe that similar fault was involved in providing the evidence

that is being disregarded.

Consider all evidence in the case record before determining whether

specific evidence may be disregarded.

Apply the preponderance of evidence standard, as defined in this

Ruling.

Fully document the record with the evidence that was the basis for the

finding that, based on a preponderance of the evidence, there is reason

to believe that similar fault was involved in providing the evidence

that is being disregarded.

D. Notice of Determination or Decision

In determinations or decisions that involve a finding of similar fault

and disregarding evidence, the notice of determination or decision must:

- Explain the applicable provision of the Act that allows

the adjudicator to disregard particular evidence due to a similar

fault finding.

ult was involved in providing the evidence

that is being disregarded.

D. Notice of Determination or Decision

In determinations or decisions that involve a finding of similar fault

and disregarding evidence, the notice of determination or decision must:

- Explain the applicable provision of the Act that allows

the adjudicator to disregard particular evidence due to a similar

fault finding.

- Identify the documents or other evidence that is being

disregarded.

- Provide a discussion of the evidence that supports a finding to

disregard evidence. The discussion must explain that, in accordance with

the law, the evidence identified cannot be used as evidence in the claim

because, after considering all the information in the case record, the

adjudicator has reason to believe that similar fault was involved in

providing the evidence and it must be disregarded. Again, a similar fault

finding can be made only if there is reason to believe, based on a

preponderance of the evidence, the person knew that the evidence provided

was false or incomplete. A similar fault finding cannot be based on

speculation or suspicion.

- Provide a determination or decision based on an evaluation of the

remaining evidence in accordance with other rules and procedures.

A similar fault finding does not constitute complete adjudicative action

in any claim. A person may still be found entitled to, or eligible for,

monthly benefits despite the fact that some evidence in the case record

has been disregarded based on similar fault. For example, a person may be

found to be under a disability based on impairments that are established

by evidence that is not disregarded because of similar fault.

- Include standard appeal language.

Explain the applicable provision of the Act that allows

the adjudicator to disregard particular evidence due to a similar

fault finding.

Identify the documents or other evidence that is being

disregarded.

person may be

found to be under a disability based on impairments that are established

by evidence that is not disregarded because of similar fault.

- Include standard appeal language.

Explain the applicable provision of the Act that allows

the adjudicator to disregard particular evidence due to a similar

fault finding.

Identify the documents or other evidence that is being

disregarded.

Provide a discussion of the evidence that supports a finding to

disregard evidence. The discussion must explain that, in accordance with

the law, the evidence identified cannot be used as evidence in the claim

because, after considering all the information in the case record, the

adjudicator has reason to believe that similar fault was involved in

providing the evidence and it must be disregarded. Again, a similar fault

finding can be made only if there is reason to believe, based on a

preponderance of the evidence, the person knew that the evidence provided

was false or incomplete. A similar fault finding cannot be based on

speculation or suspicion.

Provide a determination or decision based on an evaluation of the

remaining evidence in accordance with other rules and procedures.

A similar fault finding does not constitute complete adjudicative action

in any claim. A person may still be found entitled to, or eligible for,

monthly benefits despite the fact that some evidence in the case record

has been disregarded based on similar fault. For example, a person may be

found to be under a disability based on impairments that are established

by evidence that is not disregarded because of similar fault.

Include standard appeal language.

EFFECTIVE DATE: This SSR is effective on March 14, 2016

CROSS-REFERENCES: SSR 85-23 , “Title XVI:

Reopening Supplemental Security Income Determinations at Any Time for

Similar Fault.”

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