Initial determinations are the determinations we make that are subject to administrative and judicial review. We will base our initial determination on the preponderance of the evidence. We will state the important facts and give the reasons for our conclusions in the initial determination. In the old age, survivors' and disability insurance programs, initial determinations include, but are not limited to, determinations about—
(a) Your entitlement or your continuing entitlement to benefits;
(b) Your reentitlement to benefits;
(c) The amount of your benefit;
(d) A recomputation of your benefit;
(e) A reduction in your disability benefits because you also receive benefits under a workmen's compensation law;
(f) A deduction from your benefits on account of work;
(g) [Reserved]
(h) Termination of your benefits;
(i) Penalty deductions imposed because you failed to report certain events;
(j) Any overpayment or underpayment of your benefits;
(k) Whether an overpayment of benefits must be repaid to us;
(l) How an underpayment of benefits due a deceased person will be paid;
(m) The establishment or termination of a period of disability;
(n) A revision of your earnings record;
(o) Whether the payment of your benefits will be made, on your behalf, to a representative payee;
(p) Your drug addiction or alcoholism;
(q) Who will act as your payee if we determine that representative payment will be made;
(r) An offset of your benefits under § 404.408b because you previously received supplemental security income payments for the same period;
(s) Whether your completion of, or continuation for a specified period of time in, an appropriate program of vocational rehabilitation services, employment services, or other support services will increase the likelihood that you will not have to return to the disability benefit rolls, and thus, whether your benefits may be continued even though you are not disabled;
(t) Nonpayment of your benefits under § 404.468 because of your confinement in a jail, prison, or other penal institution or correctional facility for conviction of a felony;
(u) Whether or not you have a disabling impairment(s) as defined in § 404.1511;
(v) Nonpayment of your benefits under § 404.469 because you have not furnished us satisfactory proof of your Social Security number, or, if a Social Security number has not been assigned to you, you have not filed a proper application for one;
(w) A claim for benefits under § 404.633 based on alleged misinformation; and
(x) Whether we were negligent in investigating or monitoring or failing to investigate or monitor your representative payee, which resulted in the misuse of benefits by your representative payee.
[45 FR 52081, Aug. 5, 1980, as amended at 47 FR 4988, Feb. 3, 1982; 47 FR 31543, July 21, 1982; 49 FR 22272, May 29, 1984; 50 FR 20902, May 21, 1985; 56 FR 41790, Aug. 23, 1991; 59 FR 44925, Aug. 31, 1994; 60 FR 8147, Feb. 10, 1995; 68 FR 40123, July 7, 2003; 69 FR 60232, Oct. 7, 2004; 70 FR 36507, June 24, 2005; 73 FR 76943, Dec. 18, 2008]
Notes of Decisions
Cited in
80
cases (
25 in the last 5 years), 1969–2025 · leading case:
Sullivan v. Everhart, 494 U.S. 83 (1990).
Sullivan v. Everhart, 494 U.S. 83 (1990).
· cites it 2× “See 20 CFR §§ 404.902 , 416.1402 (1989). Needless to say, that formal determination will not be simultaneous with the Secretary's first discovery that something is amiss; delay is inevitable.”
In re Ryan W., 76 A.3d 1049 (Md. 2013).
· cites it 3× “20 C.F.R. § 404.902 . “Initial determinations” are defined by regulation (somewhat circularly) as decisions made by the SSA which are subject to administrative and judicial review.”
In re the Est. of Kummer, 93 A.D.2d 135 (N.Y. App. Div. 1983).
· cites it 2× “nt of the payment, termination of benefits, the establishment of the period of disability, the need for payment to a representative payee on behalf of a beneficiary who is 18 years of age or older and who has not been declared legally incompetent, and who will act as…”
Sipp v. Astrue, 641 F.3d 975 (8th Cir. 2011).
“Sipp received notice of the overpayment and failed to request reconsideration within sixty days.”
Nellie Pohlmeyer v. Sec'y of Health & Human Servs., 939 F.2d 318 (6th Cir. 1991).
· cites it 2× “” The regulation at 20 C.F.R. § 404.902 lists a number of administrative actions that are “initial determinations” subject to administrative and then judicial review.”
Hall v. Sebelius, 689 F. Supp. 2d 10 (D.D.C. 2009).
“20 C.F.R. § 404.902 ("[I]nitial determinations include, but are not limited to, determinations about (a) Your entitlement or your continuing entitlement to benefits.”
Escalera v. Comm'r of Soc. Sec., 457 F. App'x 4 (2d Cir. 2011).
“The reconsideration determination is binding unless a claimant requests a hearing before an administrative law judge (“ALJ”) within 60 days of receiving notice of the reconsideration determination.”
Cost v. Soc. Sec. Admin., 770 F. Supp. 2d 45 (D.D.C. 2011).
“The reconsideration determination is binding unless a claimant requests a hearing before an administrative law judge (“ALJ”) within sixty days of receiving notice of the reconsideration determination.”
Grace Thru Faith v. Caldwell, 944 S.W.2d 607 (Tenn. Ct. App. 1996).
“Furthermore, the regulations do not list the SSA’s acceptance of a representative payee’s accounting as an “initial determination” subject to agency review or as an “action that is not an initial determination” that may still be subject to limited agency review.”
Jane C. BACON, Appellant, v. Louis W. SULLIVAN, Sec'y of Health & Human Servs., 969 F.2d 1517 (3rd Cir. 1992).
“Examples of administrative actions which are “initial determinations” are given in 20 C.F.R. § 404.902 (1991). These include findings of fact and decisions as to the rights of any individual applying for a payment, and as such are subject to administrative and judicial review…”
— 20 C.F.R. § 404.902(a) — 2 cases
— 20 C.F.R. § 404.902(c) — 1 case
— 20 C.F.R. § 404.902(o) — 1 case
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