20 C.F.R. § 416.1403

Administrative actions that are not initial determinations

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(a) 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 about—

(1) Presumptive disability or presumptive blindness;

(2) An emergency advance payment (as defined in § 416.520(b));

(3) Denial of a request to be made a representative payee;

(4) Denial of a request to use the expedited appeals process;

(5) Denial of a request to reopen a determination or a decision;

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

(7) Refusing to recognize, disqualifying, or suspending a person from acting as your representative in a proceeding before us (see §§ 416.1505 and 416.1545);

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

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

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

(11) Determining whether an organization may collect a fee from you for expenses it incurs in serving as your representative payee (see § 416.640a);

(12) Declining under § 416.351(f) to make a determination on a claim for benefits based on alleged misinformation because one or more of the conditions specified in § 416.351(f) are not met;

(13) Transition to eligibility for special SSI cash benefits (§ 416.262) in a month immediately following a month for which you were eligible for regular SSI benefits;

(14) Transition to eligibility for regular SSI benefits in a month immediately following a month for which you were eligible for special SSI cash benefits (§ 416.262);

(15) The determination to reduce, suspend, or terminate your federally administered State supplementary payments due to a State-initiated mass change, as defined in § 416.1401, in the levels of such payments, except as provided in § 416.1402(n);

(16) Termination of Federal administration of State supplementary payments;

(17) Findings on whether we can collect an overpayment by using the Federal income tax refund offset procedure. (see § 416.583);

(18) Determining whether we will refer information about your overpayment to a consumer reporting agency (see §§ 416.590 and 422.305 of this chapter);

(19) Determining whether we will refer your overpayment to the Department of the Treasury for collection by offset against Federal payments due you (see §§ 416.590 and 422.310 of this chapter);

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

(21) Determining when provisional benefits are payable, the amount of the provisional benefit payable, and when provisional benefits terminate (see § 416.999c);

(22) Determining whether to select your claim for the quick disability determination process under § 416.1019;

(23) The removal of your claim from the quick disability determination process under § 416.1019;

(24) Starting or discontinuing a continuing disability review;

(25) Issuing a receipt in response to your report of a change in your earned income; and

(26) Determining whether a non-attorney representative is eligible to receive direct fee payment as described in § 416.1517 of this part.

(b) We send some notices of actions that are not initial determinations:

(1) If you receive an emergency advance payment; presumptive disability or presumptive blindness payment, or provisional payment, we will provide a notice explaining the nature and conditions of the payments.

(2) If you receive presumptive disability or presumptive blindness payments, or provisional payments, we shall send you a notice when those payments are exhausted.

(3) If there is a termination of Federal administration of State supplementary payments.

[45 FR 52096, Aug. 5, 1980, as amended at 51 FR 8809, Mar. 14, 1986; 55 FR 1020, Jan. 11, 1990; 55 FR 4423, Feb. 8, 1990; 57 FR 23058, June 1, 1992; 59 FR 41405, Aug. 12, 1994; 59 FR 43039, Aug. 22, 1994; 59 FR 44928, Aug. 31, 1994; 62 FR 49440, Sept. 22, 1997; 66 FR 67081, Dec. 28, 2001; 68 FR 74184, Dec. 23, 2003; 70 FR 57146, Sept. 30, 2005; 71 FR 16461, Mar. 31, 2006; 71 FR 66859, 66867, Nov. 17, 2006; 72 FR 51178, Sept. 6, 2007; 76 FR 45194, July 28, 2011; 76 FR 80247, Dec. 23, 2011; 80 FR 400, Jan. 6, 2015]

Notes of Decisions

Cited in 24 cases (6 in the last 5 years), 1981–2024 · leading case: Harper v. Bowen

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Harper v. Bowen (1987) ca5 · cites it 6× “See 20 C.F.R. § 416.1403 (a)(8). In this case, Harper did not submit a request for review to the Appeals Council within 60 days of the AU’s decision.”

Terry R. Finnegan, Sr. v. David Matthews, Secretary of Health, Education and Welfare of the United States (1981) ca9 “20 C.F.R. § 416.1403 (a). HEW reasons that since Finnegan was being “converted” to the federal SSI program, and since the grandfather clause should not be read to displace regulation 416.”

James MATLOCK, Plaintiff-Appellant, v. Louis W. SULLIVAN, Etc., Defendant-Appellee (1990) ca9 “See 20 C.F.R. § 416.1403 (a)(8) (1989); Harper, <a href="/opinion/484678/17-socsecrepser-44-unemplinsrep-cch-17324-michelle-d-harper-a/#739" aria-description="Citation for case: 17 soc.”

Donald Brandyburg v. Louis W. Sullivan, Secretary of Health and Human Services (1992) ca5 “20 C.F.R. § 416.1403 lists a number of agency actions that are not initial determinations and thus are not subject to the administrative review process described above or to judicial review.”

Green v. Heckler (1984) ca5 · cites it 2× “Plaintiffs also attack the constitutionality of 20 C.F.R. § 416.1403 (a)(2), claiming that the regulation violates due process by foreclosing judicial review.”

Maiden v. Barnhart (2006) dcd “20 C.F.R. § 416.1403 (a)(8). While our Circuit has never specifically addressed the issue of whether such a decision is a “final decision” subject to review by a federal court, the overwhelming majority of appellate courts have held that a denial of an untimely request for a…”

Burbage v. Schweiker (1983) cand “20 C.F.R. § 416.1403 (a)(8). That rule is dispositive here.”

Skeens v. Shalala (1994) vawd · cites it 2× “…to review a decision by the Secretary refusing to reopen a claimant’s SSI application. 20 C.F.R. § 416.1403 (a)(5) (1993). An exception exists where such a denial violated a claimant’s constitutional rights, such as due process, or where a claimant suffered a mental infirmity…”

Eichie v. Kuakazi (2023) nysd · cites it 3× “In contrast, non-reviewable administrative decisions, such as “[d]enial of a request to be made payee;” 20 CFR § 416.1403 (a)(3), are “largely factual and procedural, rendered with little guidance from bodies of regulatory, statutory, and decisional law .”

Sheila Owen v. Andrew Saul (2020) ca9 “(quotations omitted); see 20 C.F.R. § 416.1403 (a)(5).”

Juanita Cross v. Martin O'Malley (2024) ca9 “§ 405 (g); 20 C.F.R. § 416.1403 (a)(5) (“Denial of a request to reopen a determination or a decision” is “not subject to judicial review.”

Richter v. Social Security Administration (2019) ned “…reviewed by the SSA, but are not subject to administrative or judicial review. 20 C.F.R. § 416.1403 (a). A determination about “[w]hether an overpayment of benefits must be repaid” is an initial determination. 20 C.F”

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