SSR 17-4p: Titles II and XVI: Responsibility for Developing Written Evidence

Effective Date: October 4, 2017 Federal

Register, Volume 82, No. 191, Page 46339

POLICY INTERPRETATION RULING

Purpose

This Ruling clarifies our responsibilities and those

of the claimant and the claimant's representative to develop evidence

and other information in disability and blindness claims under titles

II and XVI of the Social Security Act (Act). This Ruling applies at

all levels of our administrative review process, as described below.

Citations (Authority)

Sections 206(a) , 223(d) ,

and 1614(a) of the Social Security Act, as amended; 20 CFR 404.935 , 404.970 , 404.1512 , 404.1513 , 404.1593 , 404.1594 , 404.1614 , 404.1740 , 404.1745 , 416.912 , 416.913 , 416.993 , 416.994 , 416.1014 , 416.1435 , 416.1470 , 416.1540 , and 416.1545 .

Introduction

We need complete evidentiary records to make accurate,

consistent disability determinations and decisions at each level of our

administrative review process. Although we take a role in developing

the evidentiary record in disability claims, claimants and their

appointed representatives have the primary responsibility under the Act

to provide evidence in support of their disability or blindness claims.

Consequently, we expect claimants and their representatives to make good

faith efforts to ensure that we receive complete evidence.

Under the Act, we cannot find that an individual is

disabled “unless [he or she] furnishes such medical and other evidence

of the existence thereof as the Commissioner of Social Security

may require.” [1] This statutory provision

places primary responsibility for the development of evidence on

the claimant. Consistent with the claimant's statutory obligation to

provide us with evidence regarding his or her disability or blindness

claim, our regulations require a claimant to submit or inform us about

all evidence known to him or her that relates to whether or not he

or she is disabled or blind

This statutory provision

places primary responsibility for the development of evidence on

the claimant. Consistent with the claimant's statutory obligation to

provide us with evidence regarding his or her disability or blindness

claim, our regulations require a claimant to submit or inform us about

all evidence known to him or her that relates to whether or not he

or she is disabled or blind. [2] At the hearings level, a claimant generally must submit or inform us about

written evidence at least 5 business days before the date of his or her

scheduled hearing. [3] We adopted this 5-day

requirement in December 2016 and implemented it in May 2017, to address

unprecedented workload challenges. [4] As we explained

in the preamble to our notice of proposed rulemaking, “[w]e cannot afford

to continue postponing hearing proceedings because the record is not

complete at the time of the hearing.” [5]

A representative's duty to submit evidence is derivative

of the claimant's; [6] however, representatives must also follow our rules of conduct and

standards of responsibility for representatives. [7] Those rules impose an affirmative

duty on a representative to act with reasonable promptness to help

obtain the information or evidence that the claimant must submit and

forward the information or evidence to us as soon as practicable. [8] A representative also

has an affirmative duty to assist a claimant in complying, as soon as

practicable, with our requests for information or evidence. [9]

This Ruling explains the requirement to submit or

inform us about evidence and clarifies who has the final responsibility

to obtain written evidence.

Policy Interpretation

ward the information or evidence to us as soon as practicable. [8] A representative also

has an affirmative duty to assist a claimant in complying, as soon as

practicable, with our requests for information or evidence. [9]

This Ruling explains the requirement to submit or

inform us about evidence and clarifies who has the final responsibility

to obtain written evidence.

Policy Interpretation

- Statutory Provisions In general, an individual has a statutory obligation

to provide us with evidence to prove to us that he or she is disabled

or blind. The Act also precludes us from finding that an individual

is disabled or blind unless he or she submits such evidence to us. [10] The Act also provides that we “shall consider all

evidence available in [an] individual's case record, and shall develop

a complete medical history of at least the preceding twelve months for

any case in which a determination is made that the individual is not

under a disability.” [11] In addition, when we make any determination, the Act requires us to “make

every reasonable effort to obtain from the individual's treating physician

(or other treating health care provider) all medical evidence, including

diagnostic tests, necessary in order to properly make such determination,

prior to evaluating medical evidence obtained from any other source on

a consultative basis.” [12] Thus, although a claimant has the primary responsibility

to submit evidence related to his or her disability or blindness claim,

the Act also gives us a role in developing evidence. Our statutory

responsibilities to ensure that we develop a complete 12-month medical

history when we make a determination about whether an individual is

under a disability, and to make every reasonable effort to obtain from

a claimant's treating source all medical evidence that we need to make

a determination before we evaluate medical evidence from a consultative

examiner, does not, however, reduce the claimant's responsibilities in

any way.

elop a complete 12-month medical

history when we make a determination about whether an individual is

under a disability, and to make every reasonable effort to obtain from

a claimant's treating source all medical evidence that we need to make

a determination before we evaluate medical evidence from a consultative

examiner, does not, however, reduce the claimant's responsibilities in

any way.

- An Individual's Affirmative Duty to

Provide Written Evidence Our regulations require an individual to submit

or inform us about all evidence known to him or her that relates

to whether or not he or she is disabled or blind. [13] This duty is ongoing and requires

an individual to disclose any additional evidence about which

he or she becomes aware. This duty applies at each level of the

administrative review process, including the Appeals Council level

if the evidence relates to the period on or before the date of the

administrative law judge (ALJ) hearing decision. [14] Generally, individuals must submit or inform

us about any written evidence no later than 5 business days prior

to the date of the scheduled hearing before an ALJ. [15] The ALJ may decline to consider or

obtain any evidence if disclosure takes place after this date, unless

certain circumstances outlined in the regulations apply. [16] We expect individuals to exercise their reasonable

good faith judgment about what evidence “relates” to their

disability claims. [17] Evidence

that may relate to whether or not a claimant is blind or disabled

includes objective medical evidence, medical opinion evidence, other

medical evidence, and evidence from nonmedical sources

certain circumstances outlined in the regulations apply. [16] We expect individuals to exercise their reasonable

good faith judgment about what evidence “relates” to their

disability claims. [17] Evidence

that may relate to whether or not a claimant is blind or disabled

includes objective medical evidence, medical opinion evidence, other

medical evidence, and evidence from nonmedical sources. [18] To satisfy the claimant's obligation under the

regulations to “inform” us about written evidence, he or she must

provide information specific enough to identify the evidence (source,

location, and dates of treatment) and show that the evidence relates

to the individual's medical condition, work activity, job history,

medical treatment, or other issues relevant to whether or not the

individual is disabled or blind. If the individual does not provide

us with information specific enough to allow us to identify the written

evidence and understand how it relates to whether or not the individual

is disabled or blind, the individual has not informed us about evidence

within the meaning of 20 CFR 404.935 , 404.1512 , 416.912 or 416.1435 ,

and we will not request that evidence.

- A Representative's Affirmative Duty

to Assist in Developing Written Evidence Our regulations require appointed representatives to

assist claimants in complying fully with their responsibilities under the

Act and our regulations. All representatives must faithfully execute

their duties as agents and fiduciaries of claimants. In that regard,

representatives must assist claimants in satisfying the claimants'

duties regarding the submission of evidence and in complying with our

requests for information or evidence as outlined in the prior section. [19] In addition to these responsibilities, a representative

has an affirmative duty to provide competent assistance to the

claimant, including acting with reasonable promptness to help obtain

information or evidence the claimant must submit

e claimants'

duties regarding the submission of evidence and in complying with our

requests for information or evidence as outlined in the prior section. [19] In addition to these responsibilities, a representative

has an affirmative duty to provide competent assistance to the

claimant, including acting with reasonable promptness to help obtain

information or evidence the claimant must submit. [20] To fulfill his or her affirmative

duties under our rules, the representative must forward this information

or evidence to us and must assist the claimant in complying with

our requests for information or evidence as soon as practicable. [21] In addition,

under our rules of conduct, the representative is prohibited from,

through his or her own actions or omissions, unreasonably delaying

or causing to be delayed, without good cause, the processing of a

claim at any stage of the administrative decisionmaking process. [22] Representatives are

also prohibited from engaging in actions or behavior prejudicial to the

fair and orderly conduct of administrative proceedings. [23] A representative's failure to comply

with his or her affirmative duties (or his or her engagement in prohibited

actions) could result in disciplinary action. While our regulations state that a claimant must

submit or inform us of all written evidence at least 5 business days

prior to a hearing, our rules of conduct place additional requirements

on representatives. As discussed above, under the rules of conduct,

representatives are: 1) required to act with reasonable promptness to

help obtain information or evidence the claimant must submit; 2) required

to assist the claimant in complying with our requests for information

or evidence as soon as practicable; 3) prohibited from unreasonably

delaying or causing a delay of the processing of a claim without good

cause; and 4) prohibited from actions or behavior prejudicial to the

fair and orderly conduct of administrative proceedings

n information or evidence the claimant must submit; 2) required

to assist the claimant in complying with our requests for information

or evidence as soon as practicable; 3) prohibited from unreasonably

delaying or causing a delay of the processing of a claim without good

cause; and 4) prohibited from actions or behavior prejudicial to the

fair and orderly conduct of administrative proceedings. Therefore,

we expect representatives to submit or inform us about written evidence

as soon as they obtain or become aware of it. Representatives should

not wait until 5 business days before the hearing to submit or inform

us about written evidence unless they have compelling reasons for the

delay (e.g., it was impractical to submit the evidence earlier because

it was difficult to obtain or the representative was not aware of the

evidence at an earlier date). In addition, it is only acceptable for

a representative to inform us about evidence without submitting it if

the representative shows that, despite good faith efforts, he or she

could not obtain the evidence. Simply informing us of the existence of

evidence without providing it or waiting until 5 days before a hearing

to inform us about or provide evidence when it was otherwise available,

may cause unreasonable delay to the processing of the claim, without

good cause, and may be prejudicial to the fair and orderly conduct of

our administrative proceedings. As such, this behavior could be found

to violate our rules of conduct and could lead to sanction proceedings

against the representative. Pursuant to the Act, we may, after due notice and

opportunity for hearing, suspend or prohibit from further practice before

the Commissioner a representative who refuses to comply with our rules

and regulations or who violates any provision for which a penalty is

prescribed. [24] We will evaluate each circumstance on a case-by-case

basis to determine whether to refer a possible violation of our rules to

our Office of the General Counsel (OGC)

pportunity for hearing, suspend or prohibit from further practice before

the Commissioner a representative who refuses to comply with our rules

and regulations or who violates any provision for which a penalty is

prescribed. [24] We will evaluate each circumstance on a case-by-case

basis to determine whether to refer a possible violation of our rules to

our Office of the General Counsel (OGC). For example, in accordance with

the regulatory interpretation discussed above, we may refer a possible

violation of rules to OGC when: a representative informs us about written evidence but refuses,

without good cause, to make good faith efforts to obtain and timely

submit the evidence; a representative informs us about evidence that relates to a

claim instead of acting with reasonable promptness to help obtain and

timely submit the evidence to us; the representative waits until 5 days before a hearing to provide

or inform us of evidence when the evidence was known to the representative

or available to provide to us at an earlier date; the clients of a particular representative have a pattern of

informing us about written evidence instead of making good-faith efforts

to obtain and timely submit the evidence; or any other occasion when a representative's actions with regard to

the submission of evidence may violate our rules for representatives. When we refer a possible violation to OGC, it does

not change our duties with respect to the development of the evidence. [25]

ve a pattern of

informing us about written evidence instead of making good-faith efforts

to obtain and timely submit the evidence; or any other occasion when a representative's actions with regard to

the submission of evidence may violate our rules for representatives. When we refer a possible violation to OGC, it does

not change our duties with respect to the development of the evidence. [25]

- Our Duty to Assist Claimants in Developing Written

Evidence Before we make a determination that an individual is

not disabled, we must develop the individual's complete medical history,

generally for at least 12 months preceding the month in which he or she

applied for benefits. [26] We will make every reasonable effort to help individuals obtain medical

evidence from their own medical sources and entities that maintain

medical evidence when the individual gives us permission to request

the information. [27] Every reasonable effort means that we will make an initial request for

evidence from the medical source or entity that maintains the medical

evidence, and, at any time between 10 and 20 calendar days after the

initial request, if the evidence has not been received, we will make

a follow-up request to obtain the medical evidence necessary to make a

determination. [28] We will assist with developing the record and may

request existing evidence directly from a medical source or entity that

maintains the evidence if: we were informed about the evidence (in the manner explained above)

no later than 5 business days before the date of the scheduled hearing;

or we were not informed about the evidence at least 5 business days

before the date of the scheduled hearing, but one of the circumstances

listed in 20 CFR 404.935(b) or 416.1535(b) applies. We will first ask the individual or representative

to submit the evidence

nformed about the evidence (in the manner explained above)

no later than 5 business days before the date of the scheduled hearing;

or we were not informed about the evidence at least 5 business days

before the date of the scheduled hearing, but one of the circumstances

listed in 20 CFR 404.935(b) or 416.1535(b) applies. We will first ask the individual or representative

to submit the evidence. However, if the individual or representative

shows that he or she is unable to obtain the evidence despite good

faith efforts or for reasons beyond his or her control, we may request

the evidence directly from the medical source or entity that maintains

the evidence. At the Appeals Council level of review, development of

evidence is more limited. The Appeals Council will not obtain or evaluate

additional evidence when deciding whether to grant review unless: one of the circumstances listed in 20 CFR

404.970(b) or 416.1470(b) applies and the individual or his or her representative shows that the

evidence is related to the period on or before the date of the hearing

level decision; or the claim is a title XVI claim that is not based on an application

for benefits (e.g., an age-18 redetermination).

Statutory Provisions

In general, an individual has a statutory obligation

to provide us with evidence to prove to us that he or she is disabled

or blind. The Act also precludes us from finding that an individual

is disabled or blind unless he or she submits such evidence to us. [10]

claim is a title XVI claim that is not based on an application

for benefits (e.g., an age-18 redetermination).

Statutory Provisions

In general, an individual has a statutory obligation

to provide us with evidence to prove to us that he or she is disabled

or blind. The Act also precludes us from finding that an individual

is disabled or blind unless he or she submits such evidence to us. [10]

The Act also provides that we “shall consider all

evidence available in [an] individual's case record, and shall develop

a complete medical history of at least the preceding twelve months for

any case in which a determination is made that the individual is not

under a disability.” [11] In addition, when we make any determination, the Act requires us to “make

every reasonable effort to obtain from the individual's treating physician

(or other treating health care provider) all medical evidence, including

diagnostic tests, necessary in order to properly make such determination,

prior to evaluating medical evidence obtained from any other source on

a consultative basis.” [12]

Thus, although a claimant has the primary responsibility

to submit evidence related to his or her disability or blindness claim,

the Act also gives us a role in developing evidence. Our statutory

responsibilities to ensure that we develop a complete 12-month medical

history when we make a determination about whether an individual is

under a disability, and to make every reasonable effort to obtain from

a claimant's treating source all medical evidence that we need to make

a determination before we evaluate medical evidence from a consultative

examiner, does not, however, reduce the claimant's responsibilities in

any way.

An Individual's Affirmative Duty to

Provide Written Evidence

nation about whether an individual is

under a disability, and to make every reasonable effort to obtain from

a claimant's treating source all medical evidence that we need to make

a determination before we evaluate medical evidence from a consultative

examiner, does not, however, reduce the claimant's responsibilities in

any way.

An Individual's Affirmative Duty to

Provide Written Evidence

Our regulations require an individual to submit

or inform us about all evidence known to him or her that relates

to whether or not he or she is disabled or blind. [13] This duty is ongoing and requires

an individual to disclose any additional evidence about which

he or she becomes aware. This duty applies at each level of the

administrative review process, including the Appeals Council level

if the evidence relates to the period on or before the date of the

administrative law judge (ALJ) hearing decision. [14]

Generally, individuals must submit or inform

us about any written evidence no later than 5 business days prior

to the date of the scheduled hearing before an ALJ. [15] The ALJ may decline to consider or

obtain any evidence if disclosure takes place after this date, unless

certain circumstances outlined in the regulations apply. [16]

We expect individuals to exercise their reasonable

good faith judgment about what evidence “relates” to their

disability claims. [17] Evidence

that may relate to whether or not a claimant is blind or disabled

includes objective medical evidence, medical opinion evidence, other

medical evidence, and evidence from nonmedical sources. [18]

circumstances outlined in the regulations apply. [16]

We expect individuals to exercise their reasonable

good faith judgment about what evidence “relates” to their

disability claims. [17] Evidence

that may relate to whether or not a claimant is blind or disabled

includes objective medical evidence, medical opinion evidence, other

medical evidence, and evidence from nonmedical sources. [18]

To satisfy the claimant's obligation under the

regulations to “inform” us about written evidence, he or she must

provide information specific enough to identify the evidence (source,

location, and dates of treatment) and show that the evidence relates

to the individual's medical condition, work activity, job history,

medical treatment, or other issues relevant to whether or not the

individual is disabled or blind. If the individual does not provide

us with information specific enough to allow us to identify the written

evidence and understand how it relates to whether or not the individual

is disabled or blind, the individual has not informed us about evidence

within the meaning of 20 CFR 404.935 , 404.1512 , 416.912 or 416.1435 ,

and we will not request that evidence.

A Representative's Affirmative Duty

to Assist in Developing Written Evidence

Our regulations require appointed representatives to

assist claimants in complying fully with their responsibilities under the

Act and our regulations. All representatives must faithfully execute

their duties as agents and fiduciaries of claimants. In that regard,

representatives must assist claimants in satisfying the claimants'

duties regarding the submission of evidence and in complying with our

requests for information or evidence as outlined in the prior section. [19]

fully with their responsibilities under the

Act and our regulations. All representatives must faithfully execute

their duties as agents and fiduciaries of claimants. In that regard,

representatives must assist claimants in satisfying the claimants'

duties regarding the submission of evidence and in complying with our

requests for information or evidence as outlined in the prior section. [19]

In addition to these responsibilities, a representative

has an affirmative duty to provide competent assistance to the

claimant, including acting with reasonable promptness to help obtain

information or evidence the claimant must submit. [20] To fulfill his or her affirmative

duties under our rules, the representative must forward this information

or evidence to us and must assist the claimant in complying with

our requests for information or evidence as soon as practicable. [21] In addition,

under our rules of conduct, the representative is prohibited from,

through his or her own actions or omissions, unreasonably delaying

or causing to be delayed, without good cause, the processing of a

claim at any stage of the administrative decisionmaking process. [22] Representatives are

also prohibited from engaging in actions or behavior prejudicial to the

fair and orderly conduct of administrative proceedings. [23] A representative's failure to comply

with his or her affirmative duties (or his or her engagement in prohibited

actions) could result in disciplinary action.

rocessing of a

claim at any stage of the administrative decisionmaking process. [22] Representatives are

also prohibited from engaging in actions or behavior prejudicial to the

fair and orderly conduct of administrative proceedings. [23] A representative's failure to comply

with his or her affirmative duties (or his or her engagement in prohibited

actions) could result in disciplinary action.

While our regulations state that a claimant must

submit or inform us of all written evidence at least 5 business days

prior to a hearing, our rules of conduct place additional requirements

on representatives. As discussed above, under the rules of conduct,

representatives are: 1) required to act with reasonable promptness to

help obtain information or evidence the claimant must submit; 2) required

to assist the claimant in complying with our requests for information

or evidence as soon as practicable; 3) prohibited from unreasonably

delaying or causing a delay of the processing of a claim without good

cause; and 4) prohibited from actions or behavior prejudicial to the

fair and orderly conduct of administrative proceedings. Therefore,

we expect representatives to submit or inform us about written evidence

as soon as they obtain or become aware of it. Representatives should

not wait until 5 business days before the hearing to submit or inform

us about written evidence unless they have compelling reasons for the

delay (e.g., it was impractical to submit the evidence earlier because

it was difficult to obtain or the representative was not aware of the

evidence at an earlier date). In addition, it is only acceptable for

a representative to inform us about evidence without submitting it if

the representative shows that, despite good faith efforts, he or she

could not obtain the evidence

reasons for the

delay (e.g., it was impractical to submit the evidence earlier because

it was difficult to obtain or the representative was not aware of the

evidence at an earlier date). In addition, it is only acceptable for

a representative to inform us about evidence without submitting it if

the representative shows that, despite good faith efforts, he or she

could not obtain the evidence. Simply informing us of the existence of

evidence without providing it or waiting until 5 days before a hearing

to inform us about or provide evidence when it was otherwise available,

may cause unreasonable delay to the processing of the claim, without

good cause, and may be prejudicial to the fair and orderly conduct of

our administrative proceedings. As such, this behavior could be found

to violate our rules of conduct and could lead to sanction proceedings

against the representative.

Pursuant to the Act, we may, after due notice and

opportunity for hearing, suspend or prohibit from further practice before

the Commissioner a representative who refuses to comply with our rules

and regulations or who violates any provision for which a penalty is

prescribed. [24]

We will evaluate each circumstance on a case-by-case

basis to determine whether to refer a possible violation of our rules to

our Office of the General Counsel (OGC). For example, in accordance with

the regulatory interpretation discussed above, we may refer a possible

violation of rules to OGC when:

rules

and regulations or who violates any provision for which a penalty is

prescribed. [24]

We will evaluate each circumstance on a case-by-case

basis to determine whether to refer a possible violation of our rules to

our Office of the General Counsel (OGC). For example, in accordance with

the regulatory interpretation discussed above, we may refer a possible

violation of rules to OGC when:

- a representative informs us about written evidence but refuses,

without good cause, to make good faith efforts to obtain and timely

submit the evidence; a representative informs us about evidence that relates to a

claim instead of acting with reasonable promptness to help obtain and

timely submit the evidence to us; the representative waits until 5 days before a hearing to provide

or inform us of evidence when the evidence was known to the representative

or available to provide to us at an earlier date; the clients of a particular representative have a pattern of

informing us about written evidence instead of making good-faith efforts

to obtain and timely submit the evidence; or any other occasion when a representative's actions with regard to

the submission of evidence may violate our rules for representatives.

a representative informs us about written evidence but refuses,

without good cause, to make good faith efforts to obtain and timely

submit the evidence;

a representative informs us about evidence that relates to a

claim instead of acting with reasonable promptness to help obtain and

timely submit the evidence to us;

the representative waits until 5 days before a hearing to provide

or inform us of evidence when the evidence was known to the representative

or available to provide to us at an earlier date;

the clients of a particular representative have a pattern of

informing us about written evidence instead of making good-faith efforts

to obtain and timely submit the evidence; or

bmit the evidence to us;

the representative waits until 5 days before a hearing to provide

or inform us of evidence when the evidence was known to the representative

or available to provide to us at an earlier date;

the clients of a particular representative have a pattern of

informing us about written evidence instead of making good-faith efforts

to obtain and timely submit the evidence; or

any other occasion when a representative's actions with regard to

the submission of evidence may violate our rules for representatives.

When we refer a possible violation to OGC, it does

not change our duties with respect to the development of the evidence. [25]

Our Duty to Assist Claimants in Developing Written

Evidence

Before we make a determination that an individual is

not disabled, we must develop the individual's complete medical history,

generally for at least 12 months preceding the month in which he or she

applied for benefits. [26] We will make every reasonable effort to help individuals obtain medical

evidence from their own medical sources and entities that maintain

medical evidence when the individual gives us permission to request

the information. [27] Every reasonable effort means that we will make an initial request for

evidence from the medical source or entity that maintains the medical

evidence, and, at any time between 10 and 20 calendar days after the

initial request, if the evidence has not been received, we will make

a follow-up request to obtain the medical evidence necessary to make a

determination. [28]

We will assist with developing the record and may

request existing evidence directly from a medical source or entity that

maintains the evidence if:

ins the medical

evidence, and, at any time between 10 and 20 calendar days after the

initial request, if the evidence has not been received, we will make

a follow-up request to obtain the medical evidence necessary to make a

determination. [28]

We will assist with developing the record and may

request existing evidence directly from a medical source or entity that

maintains the evidence if:

- we were informed about the evidence (in the manner explained above)

no later than 5 business days before the date of the scheduled hearing;

or we were not informed about the evidence at least 5 business days

before the date of the scheduled hearing, but one of the circumstances

listed in 20 CFR 404.935(b) or 416.1535(b) applies.

we were informed about the evidence (in the manner explained above)

no later than 5 business days before the date of the scheduled hearing;

or

we were not informed about the evidence at least 5 business days

before the date of the scheduled hearing, but one of the circumstances

listed in 20 CFR 404.935(b) or 416.1535(b) applies.

We will first ask the individual or representative

to submit the evidence. However, if the individual or representative

shows that he or she is unable to obtain the evidence despite good

faith efforts or for reasons beyond his or her control, we may request

the evidence directly from the medical source or entity that maintains

the evidence.

At the Appeals Council level of review, development of

evidence is more limited. The Appeals Council will not obtain or evaluate

additional evidence when deciding whether to grant review unless:

- one of the circumstances listed in 20 CFR

404.970(b) or 416.1470(b) applies and the individual or his or her representative shows that the

evidence is related to the period on or before the date of the hearing

level decision; or the claim is a title XVI claim that is not based on an application

for benefits (e.g., an age-18 redetermination).

ce when deciding whether to grant review unless:

- one of the circumstances listed in 20 CFR

404.970(b) or 416.1470(b) applies and the individual or his or her representative shows that the

evidence is related to the period on or before the date of the hearing

level decision; or the claim is a title XVI claim that is not based on an application

for benefits (e.g., an age-18 redetermination).

one of the circumstances listed in 20 CFR

404.970(b) or 416.1470(b) applies and the individual or his or her representative shows that the

evidence is related to the period on or before the date of the hearing

level decision; or

the claim is a title XVI claim that is not based on an application

for benefits (e.g., an age-18 redetermination).

1 Sections 223(d)(5)(A) and 1614(a)(3)(H)(i) of the

Act, 42 USC 423(d)(5)(A) and 1382c(a)(3)(H)(i).

2 20 CFR 404.1512(a) and 416.912(a) .

3 20 CFR 404.935(a) and 416.1435(a) .

4 81 FR 90987.

5 81 FR 45079, 45080 (2016).

6 20 CFR 404.1710(a) and 416.1510(a) .

7 20 CFR 404.1740 and 416.1540 .

8 20 CFR 404.1740(b)(1) and 416.1540(b)(1) .

9 20 CFR 404.1740(b)(2) and 416.1540(b)(2) .

10 See sections 223(d)(5)(A) and 1614(a)(3)(H)(i) of

the Act, 42 USC 423(d)(5)(A) and 1382c(a)(3)(H)(i); 20 CFR 404.1512(a)(1) and 416.912(a)(1) .

11 Sections 223(d)(5)(B) and 1614(a)(3)(H)(i) of

the Act, 42 USC 423(d)(5)(B) and 1382c(a)(3)(H)(i).

12 Id.

13 20 CFR 404.1512(a)(1) and 416.912(a)(1) .

14 20 CFR 404.1512(a)(1) and 416.912(a)(1) .

15 20 CFR 404.935 and 416.1435 .

16 20 CFR 404.935(b) and 416.1425(b) .

However, for age-18 redetermination and continuing-disability review

cases under title XVI of the Act, the requirement to submit or inform

us about evidence no later than 5 business days before a scheduled

hearing does not apply if our other rules allow the claimant to

submit evidence after the date of an ALJ decision. See 20 CFR 416.1435(c) and 416.1470(b) .

17 80 FR 14828, 14829 (March 20, 2015).

or age-18 redetermination and continuing-disability review

cases under title XVI of the Act, the requirement to submit or inform

us about evidence no later than 5 business days before a scheduled

hearing does not apply if our other rules allow the claimant to

submit evidence after the date of an ALJ decision. See 20 CFR 416.1435(c) and 416.1470(b) .

17 80 FR 14828, 14829 (March 20, 2015).

18 20 CFR 404.1513(a) and 416.913(a) .

However, evidence generally does not include confidential communications

between the individual and his or her representative about providing

or obtaining legal advice, and it does not include a representative's

written analyses of the claim. 20 CFR 404.1513(b) and 416.913(b) .

19 See 20 CFR 404.1740(b)(1) , (b)(2) and 416.1540(b)(1) ,

(b)(2).

20 See 20 CFR 404.1740(b)(3) and 416.1540(b)(3) .

21 20 CFR 404.1740(b)(1) , (b)(2) and 416.1540(b)(1) ,

(b)(2).

22 20 CFR 404.1740(c)(4) and 416.1540(c)(4) .

23 20 CFR 404.1740(c)(7) and 416.1540(c)(7) .

24 42 USC 406(a)(1). See also 20 CFR 404.1745 and 416.1545 (“When we have evidence that a representative ... has violated

the rules governing dealings with us, we may begin proceedings to suspend

or disqualify that individual from acting in a representational capacity

before us.”)

25 See 20 CFR 404.935 and 416.1435 .

26 Sections 223(d)(5)(B) and 1614(a)(3)(H)(i) of

the Act, 42 USC 423(d)(5)(B) and 1382c(a)(3)(H)(i); 20 CFR

404.1512(b) and 416.912(b) .

27 20 CFR 404.1512(b)(1) and 416.912(b)(1) .

28 20 CFR 404.1512(b)(1)(i) , 404.1593(b) , 416.912(b)(1)(i) ,

and 416.993(b) .

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