C.F.R. » Title 20 » CHAPTER III—SOCIAL SECURITY ADMINISTRATION › PART 404—FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) › Subpart J—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions

20 C.F.R. § 404.903

Administrative actions that are not initial determinations

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Administrative actions that are not initial determinations may be reviewed by us, but they are not subject to the administrative review process provided by this subpart, and they are not subject to judicial review. These actions include, but are not limited to, an action—

(a) Suspending benefits pending an investigation and determination of any factual issue relating to a deduction on account of work;

(b) Suspending benefits pending an investigation to determine if your disability has ceased;

(c) Denying a request to be made a representative payee;

(d) Certifying two or more family members for joint payment of benefits;

(e) Withholding less than the full amount of your monthly benefit to recover an overpayment;

(f) Determining the fee that may be charged or received by a person who has represented you in connection with a proceeding before us;

(g) Refusing to recognize, disqualifying, or suspending a person from acting as your representative in a proceeding before us (see §§ 404.1705 and 404.1745);

(h) Compromising, suspending or terminating collection of an overpayment under the Federal Claims Collection Act;

(i) Extending or not extending the time to file a report of earnings;

(j) Denying your request to extend the time period for requesting review of a determination or a decision;

(k) Denying your request to use the expedited appeals process;

(l) Denying your request to reopen a determination or a decision;

(m) Withholding temporarily benefits based on a wage earner's estimate of earnings to avoid creating an overpayment;

(n) Determining whether (and the amount of) travel expenses incurred are reimbursable in connection with proceedings before us;

(o) Denying your request to readjudicate your claim and apply an Acquiescence Ruling;

(p) Findings on whether we can collect an overpayment by using the Federal income tax refund offset procedure (see § 404.523);

(q) Determining whether an organization may collect a fee from you for expenses it incurred in serving as your representative payee (see § 404.2040a);

(r) Declining under § 404.633(f) to make a determination on a claim for benefits based on alleged misinformation because one or more of the conditions specified in § 404.633(f) are not met;

(s) The assignment of a monthly payment day (see § 404.1807);

(t) Determining whether we will refer information about your overpayment to a consumer reporting agency (see §§ 404.527 and 422.305 of this chapter);

(u) Determining whether we will refer your overpayment to the Department of the Treasury for collection by offset against Federal payments due you (see §§ 404.527 and 422.310 of this chapter);

(v) Determining whether we will order your employer to withhold from your disposable pay to collect an overpayment you received under title II of the Social Security Act (see part 422, subpart E, of this chapter);

(w) Determining whether provisional benefits are payable, the amount of the provisional benefits, and when provisional benefits terminate (see § 404.1592e);

(x) Determining whether to select your claim for the quick disability determination process under § 404.1619;

(y) The removal of your claim from the quick disability determination process under § 404.1619;

(z) Starting or discontinuing a continuing disability review;

(aa) Issuing a receipt in response to your report of a change in your work activity; and

(bb) Determining whether a non-attorney representative is eligible to receive direct fee payment as described in § 404.1717 of this part.

[45 FR 52081, Aug. 5, 1980, as amended at 51 FR 8808, Mar. 14, 1986; 55 FR 1018, Jan. 11, 1990; 56 FR 52469, Oct. 21, 1991; 57 FR 23057, June 1, 1992; 59 FR 44925, Aug. 31, 1994; 62 FR 6120, Feb. 11, 1997; 62 FR 64278, Dec. 5, 1997; 68 FR 74183, Dec. 23, 2003; 70 FR 57142, Sept. 30, 2005; 71 FR 16443, Mar. 31, 2006; 71 FR 66853, 66866, Nov. 17, 2006; 72 FR 51177, Sept. 6, 2007; 76 FR 45192, July 28, 2011; 76 FR 80245, Dec. 23, 2011; 80 FR 400, Jan. 6, 2015]
Notes of Decisions
Cited in 51 cases (11 in the last 5 years), 1983–2024 · leading case: Linda Cash v. Jo Anne B. Barnhart, Commissioner of Social Security
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Linda Cash v. Jo Anne B. Barnhart, Commissioner of Social Security (2003) ca11 “900 (a)(5) (defining a final decision for purposes of judicial review as an initial determination that has been pursued through all four steps in the administrative review process); 20 C.F.R. § 404.903 (1) (excluding a denial of a request to reopen a determination from the…”
In re the Estate of Kummer (1983) nyappdiv · cites it 2× “Those actions of the Social Security Administration which are not initial determinations may be reviewed by the administration but are not subject to reconsideration at a formal hearing, to administrative appeal, or to judicial review (see 20 CFR 404.903). Initial determinations…”
Carlos Bello v. Commissioner of Social Security (2012) ca11 · cites it 3× “The ALJ concluded that Bello did not have a right to a hearing because, pursuant to 20 C.F.R. § 404.903 (0, the SSA’s denial of Bello’s letter request for reopening was “not an initial determination giving the claimant appeal rights, so a reconsidered determination was never…”
Alam Ganem v. Margaret Heckler, Secretary of Health and Human Services (1984) cadc “See 20 C.F.R. § 404.903 (1982) (defining non-final actions to include, inter alia, the suspension of benefits pending investigation into factual issues such as deductions on account of work or investigation into whether disability has ceased).”
Jane C. BACON, Appellant, v. Louis W. SULLIVAN, Secretary of Health and Human Services (1992) ca3 “” 20 C.F.R. § 404.903 (j) (1991). Such a denial therefore is neither a “final decision” of the Secretary nor an “initial determination” subject to judicial review.”
Palomar Medical Center v. Kathleen Sebelius (2012) ca9 “926 (listing among “[ajctions that are not initial determinations and are not appealable” a Medicare contractor’s decision “to reopen or not to reopen”) (emphasis added), with 20 C.F.R. § 404.903 (listing among “[administrative actions that are not initial determinations .”
Donald Brandyburg v. Louis W. Sullivan, Secretary of Health and Human Services (1992) ca5 “The counterpart provision in Part 404 is 20 C.F.R. § 404.903 (j). 6 . By contrast, the proper response by the Appeals Council to an untimely request for review is dismissal rather than denial, 20 C.”
Theodore S. SHERROD, Plaintiff-Appellant, v. Shirley S. CHATER, Commissioner of Social Security, Defendant-Appellee (1996) ca11 “See 20 C.F.R. § 404.903 . Undeterred by his previous setbacks, Sherrod continued his quest for disability benefits by filing a complaint in the district court on April 7,1993, seeking judicial review of the ALJ’s refusal to reopen his case.”
Dana Alfreds v. Carolyn Colvin (2015) ca7 “1989); 20C.F.R. § 404.903(Z). Accordingly, the judgment of the district court is AFFIRMED.”
Dianne Weeks v. Nancy Berryhill, Acting Cmsnr (2017) ca5 “20 C.F.R. § 404.903 (0- Accordingly, federal courts lack jurisdiction to review a decision not to reopen a claim for benefits.”
Lay v. Commissioner of Social Security (2016) ca6 “See 20 C.F.R. § 404.903 (f). Because the district court altered only its order regarding attorney’s fees — it ordered no recalculation of Lay’s past-due benefits — it had subject-matter jurisdiction, and we thus, consider the merits of this appeal.”
Howard v. Apfel (1998) mowd “Pursuant to the regulatory provisions in 20 CFR 404.903 and 416.1403, you are not entitled to court review of the Administrative Law Judge’s denial of your request for reopening of the prior determination for that period.”
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— 20 C.F.R. § 404.903(Z) — 1 case
Dana Alfreds v. Carolyn Colvin (2015) ca7 “1989); 20C.F.R. § 404.903(Z). Accordingly, the judgment of the district court is AFFIRMED.”
— 20 C.F.R. § 404.903(f) — 1 case
Kaye v. Social Security Administration (2020) tnmd
— 20 C.F.R. § 404.903(i) — 1 case
Carlos Bello v. Commissioner of Social Security (2012) ca11 “The ALJ concluded that Bello did not have a right to a hearing because, pursuant to 20 C.F.R. § 404.903 (0, the SSA’s denial of Bello’s letter request for reopening was “not an initial determination giving the claimant appeal rights, so a reconsidered determination was never…”
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