SSR 88-4: POLICY INTERPRETATION RULING Title II: Administrative Actions that are not Initial Determinations

SSR 88-4

EFFECTIVE/PUBLICATION DATE: 03/10/88

PURPOSE: To state an existing policy that actions by the Social

Security Administration (SSA) to suspend benefits to Social Security

beneficiaries in foreign countries for certain specific reasons (stated

below) will not be considered "initial determinations" as described in 20

C.F.R. 404.902, and thus will not be subject to administrative review

process or judicial review as provided for in section 205(g) of the Social

Security Act and 20 CFR 404.900ff. The specific reasons for the suspension

are:

CITATIONS (AUTHORITY): Sections 202(t) and 205(a) of the Social

Security Act; 20 C.F.R., sections 404.902 and 404.903; Ganem v. Heckler,

No. 82-2880 (D.D.C. August 11, 1983), rev'd in part, 746 F.2d 844 (D.C.

Cir. 1984).

PERTINENT HISTORY: Initial determinations are determinations on

entitlement to benefits or other similar matters that are subject to

administrative and subsequent judicial review. The types of determinations

that constitute "initial determinations" are discussed in 20 C.F.R.

404.902. An initial determination generally is binding unless a

reconsideration is requested within the stated time period, or unless the

Secretary revises the initial determination (20 C.F.R. 404.905).

With regard to item (1) in the "Purpose" section above --

Section 202(t)(1) of the Social Security Act requires the suspension of

benefits after the sixth consecutive calendar month during all of which a

beneficiary who is not a citizen or a national of the United States is

outside the United States, Section 202(t)(2) provides an exception to

Section 202(t)(1) for citizens of a foreign country which the Secretary

finds has in effect a social insurance or pension system which is of

general application in such country and under which --

ixth consecutive calendar month during all of which a

beneficiary who is not a citizen or a national of the United States is

outside the United States, Section 202(t)(2) provides an exception to

Section 202(t)(1) for citizens of a foreign country which the Secretary

finds has in effect a social insurance or pension system which is of

general application in such country and under which --

The exception to section 202(t)(1) provided by section 202(t)(2) requires

a decision on the part of the Secretary and pending that decision, benefit

payments may be suspended. In addition, the exceptions to paragraph

202(t)(1) provided by subparagraphs 202(t)(4)(A) and 202(t)(4)(B) also

require a determination under paragraph 202(t)(2). Pending an

investigation to determine whether the exception in Section 202(t)(2) may

apply, the nonpayment provision in Section 202(t)(1) is applicable and,

therefore, benefits to the affected beneficiaries may need to be

suspended. Similar pending investigations that result in the suspension of

benefits are specified in 20 C.F.R. 404.903 as administrative actions that

are not initial determinations.

With regard to item (2) in the "Purpose" section above --

Section 205(a) of the Social Security Act reads as follows:

That authority is the basis for the procedures under which SSA continues

to pay benefits only when there is reasonable assurance concerning the

integrity of the payments; i.e., the beneficiary is alive, eligibility

requirements continue to be met and the beneficiary is able to receive and

use the benefits.

Where a foreign country denies SSA access to beneficiaries, there is no

sound basis for ensuring the integrity of payments. Since these

suspensions are made pending investigations which must be deferred until

the foreign government permits access to beneficiaries in that country,

they are not initial determinations subject to review but rather are the

type of action described in 202 C.F.R. 404.903.

POLICY INTERPRETATION:

access to beneficiaries, there is no

sound basis for ensuring the integrity of payments. Since these

suspensions are made pending investigations which must be deferred until

the foreign government permits access to beneficiaries in that country,

they are not initial determinations subject to review but rather are the

type of action described in 202 C.F.R. 404.903.

POLICY INTERPRETATION:

As administrative actions that are not initial determinations, the

actions noted above may e reviewed by the Secretary, but they are not

subject to the administrative review process or judicial review as

provided for in 20 C.F.R. 404.900ff.

FURTHER INFORMATION: 20 C.F.R. 404.902,which lists actions that are

initial determinations, and 20 C.F.R. 404.903, which lists actions that

are not initial determinations, provide that the actions listed are not

all-inclusive. This ruling sets forth the established policy regarding two

actions which are not initial determinations but which are not specified

in 20 C.F.F. 404.903, and thereby clarifies the nature of these

actions.

EFFECTIVE DATE:

SSA policy for nonpayment of benefits pending an investigation and

determination of Section 202(t)(2) status has been in effect since 1957

when foreign countries first had to meet the criteria in Section 202(t)(2)

of the Social Security Act as an exception to Section 202(t)(1).

The policy regarding suspension of benefits in a foreign country based on

non-access to beneficiaries has been in effect since December 1968, when

the U.S. Department of the Treasury removed the restrictions on sending

checks to the U.S.S.R., and the U.S.S.R. refused access to beneficiaries

in that country.

CROSS-REFERENCES: Program Operations Manual System, Part 3, Chapter

026, Subchapters 10 and 50.