C.F.R. » Title 20 » CHAPTER III—SOCIAL SECURITY ADMINISTRATION › PART 416—SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED › Subpart N—Determinations, Administrative Review Process, and Reopening of Determinations and Decisions

20 C.F.R. § 416.1469

Appeals Council initiates review

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(a) General. Anytime within 60 days after the date of a decision or dismissal that is subject to review under this section, the Appeals Council may decide on its own motion to review the action that was taken in your case. We may refer your case to the Appeals Council for it to consider reviewing under this authority.

(b) Identification of cases. We will identify a case for referral to the Appeals Council for possible review under its own-motion authority before we effectuate a decision in the case. We will identify cases for referral to the Appeals Council through random and selective sampling techniques, which we may use in association with examination of the cases identified by sampling. We will also identify cases for referral to the Appeals Council through the evaluation of cases we conduct in order to effectuate decisions.

(1) Random and selective sampling and case examinations. We may use random and selective sampling to identify cases involving any type of action (i.e., fully or partially favorable decisions, unfavorable decisions, or dismissals) and any type of benefits (i.e., benefits based on disability and benefits not based on disability). We will use selective sampling to identify cases that exhibit problematic issues or fact patterns that increase the likelihood of error. Neither our random sampling procedures nor our selective sampling procedures will identify cases based on the identity of the decisionmaker or the identity of the office issuing the decision. We may examine cases that have been identified through random or selective sampling to refine the identification of cases that may meet the criteria for review by the Appeals Council.

(2) Identification as a result of the effectuation process. We may refer a case requiring effectuation to the Appeals Council if, in the view of the effectuating component, the decision cannot be effectuated because it contains a clerical error affecting the outcome of the claim; the decision is clearly inconsistent with the Social Security Act, the regulations, or a published ruling; or the decision is unclear regarding a matter that affects the claim's outcome.

(c) Referral of cases. We will make referrals that occur as the result of a case examination or the effectuation process in writing. The written referral based on the results of such a case examination or the effectuation process will state the referring component's reasons for believing that the Appeals Council should review the case on its own motion. Referrals that result from selective sampling without a case examination may be accompanied by a written statement identifying the issue(s) or fact pattern that caused the referral. Referrals that result from random sampling without a case examination will only identify the case as a random sample case.

(d) Appeals Council's action. If the Appeals Council decides to review a decision or dismissal on its own motion, it will mail a notice of review to all the parties as provided in § 416.1473. The Appeals Council will include with that notice a copy of any written referral it has received under paragraph (c) of this section. The Appeals Council's decision to review a case is established by its issuance of the notice of review. If it is unable to decide within the applicable 60-day period whether to review a decision or dismissal, the Appeals Council may consider the case to determine if the decision or dismissal should be reopened pursuant to §§ 416.1487 and 416.1488. If the Appeals Council decides to review a decision on its own motion or to reopen a decision as provided in §§ 416.1487 and 416.1488, the notice of review or the notice of reopening issued by the Appeals Council will advise, where appropriate, that interim benefits will be payable if a final decision has not been issued within 110 days after the date of the decision that is reviewed or reopened, and that any interim benefits paid will not be considered overpayments unless the benefits are fraudulently obtained.

[63 FR 36571, July 7, 1998, as amended at 75 FR 33169, June 11, 2010]
Notes of Decisions
Cited in 19 cases (1 in the last 5 years), 1984–2021 · leading case: Silvis v. Heckler, 578 F. Supp. 1401 (W.D. Pa. 1984).
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Silvis v. Heckler, 578 F. Supp. 1401 (W.D. Pa. 1984). · cites it 3× “20 C.F.R. §§ 416.1469 , 404.969 (1983). For obvious reasons, the claimant did not request that the Appeals Council review the AU’s decision within sixty days as provided by the regulations.”
Ernestine KEY, Plaintiff-Appellee, v. Louis W. SULLIVAN, M.D., Sec'y of Health & Human Servs., Defendant-Appellant, 925 F.2d 1056 (7th Cir. 1991). “20 C.F.R. § 416.1469 . Key posits that because the Council assumed jurisdiction eighty-three days after AU Kortsch’s July 24, 1987, recommended decision, its assumption of jurisdiction was untimely.”
Earle E. Benton for Laurie Ann Benton v. Otis R. Bowen, Sec'y of Health & Human Servs., 820 F.2d 85 (3rd Cir. 1987). “See 20 C.F.R. § 416.1469 . . 42 C.F.R. § 435.”
Gutierrez v. Bowen, 702 F. Supp. 1050 (S.D.N.Y. 1989). · cites it 2× “20 C.F.R. § 416.1469 . The Cieutat panel noted that the sixty-day time period during which the Council may review a case on its own motion runs from the date of the AU’s hearing decision.”
Grier v. Colvin, 117 F. Supp. 3d 1335 (N.D. Ala. 2015). “Grier of its intention to review the decision reached by the attorney'advisor based on its own motion pursuant to 20 C.F.R. § 416.1469 . (Tr. 96). On October 17, 2012, the Appeals Council informed Ms.”
McCuin v. Bowen, 634 F. Supp. 431 (D.N.H. 1985). · cites it 4× “20 CFR § 416.1469 (1983). This provision is identical to 20 CFR § 404.”
Calef Ex Rel. Calef v. Barnhart, 309 F. Supp. 2d 425 (E.D.N.Y 2004). “On March 30, 2000, the Appeals Council advised the plaintiff of its intent to review, on its own motion, the ALJ’s decision under the error of law provision pursuant to 20 C.F.R. §§ 416.1469 and 416.1470. In a letter dated June 6, 2000, the Appeals Council notified the plaintiff…”
Roesch v. Apfel, 17 F. Supp. 2d 1080 (D. Neb. 1998). · cites it 2× “1468 (60 day limit for claimant to request review) with 20 C.F.R. § 416.1469 (60 day limit for Appeals Council initiation of review).”
White v. Sullivan, 813 F. Supp. 1059 (D. Vt. 1992). “20 C.F.R. § 416.1469 . The AU issued his final, amended decision on June 12, 1989.”
Wilson v. Heckler, 617 F. Supp. 899 (D. Mont. 1985). “Plaintiff cites 20 C.F.R. § 416.1469 (1983), which reads in part that “[a]nytime within 60 days after the date of a hearing decision or dismissal, the Appeals Council itself may decide to review the action that was taken.”
Panzarino v. Heckler, 624 F. Supp. 350 (S.D.N.Y. 1985). “The Appeals Council of HHS reviewed the AU decision on its own motion, pursuant to 20 C.F.R. §§ 416.1469 and 416.-1470(a)(2).”
Cleofas Montes v. Sec'y of Health & Human Servs., 16 F.3d 416 (10th Cir. 1994). “5 The Appeals Council sua sponte reviewed the administrative law judge's determination pursuant to 20 C.F.R. Part 416.1469 (1993) and found the earlier 1985 and 1987 applications could not be reopened because the time period for doing so had lapsed.”
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