42 U.S.C. § 1383 — Procedure for payment of benefits

(a) Time, manner, form, and duration of payments; representative payees; promulgation of regulations

(1) Benefits under this subchapter must be paid at the times and in the installments that best carry out this subchapter, as regulations provide. They may be paid less often than monthly when the monthly benefit would be $10 or less. Paragraph (10) provides a special rule for some past-due benefits.

(2)(A)(i) A person's benefit may be paid to that person^*, to the person's eligible spouse^*, or partly to each.

(ii)(I) If the Commissioner decides that it would be in the person's or spouse's interest, payment may instead be made to another person or organization that meets subparagraph (B), regardless of whether the person or spouse is legally competent. That recipient is the person's “representative payee,” and must use the money for the person or spouse's benefit. This section does not define “representative payee.”

(II) If a person receives benefits because of disability, the benefits must be paid to a representative payee when the Commissioner decides this is in the person's interest because the person also has an alcoholism or drug^*-addiction condition, as the Commissioner determines, and cannot manage the benefits.

(iii) If the Commissioner or a court with proper authority finds that a representative payee misused benefits paid under this clause or under section 405(j)(1) or 1007 of this title, the Commissioner must promptly stop paying that payee. The Commissioner must arrange payment to another payee or, if that would better serve the person's interest, directly to the person or spouse.

(iv) A representative payee misuses benefits when the payee receives money for another person and changes it, in whole or in part, to a use other than that person's use and benefit. The Commissioner may define “use and benefit” by regulation. This section does not define that term.

(B)(i) Before appointing a representative payee, the Commissioner must investigate the proposed payee. The investigation must, when practical, include a face-to-face interview. There must also be enough evidence, under the Commissioner's regulations, that paying the proposed payee serves the person's or spouse's interest.

(ii) The investigation must require or determine the following:

(I) The proposed payee must provide documented identity proof, unless identity information was already submitted with an application under subchapter II, VIII, or this subchapter.

(II) The Commissioner must verify the proposed payee's Social Security account number or employer identification number.

(III) The Commissioner must determine whether the person was convicted of violating section 408, 1011, or 1383a of this title.

(IV) The Commissioner must obtain information about any other Federal or State^* offense that resulted in imprisonment for more than one year.

(V) The Commissioner must obtain information about whether the person is someone described in section 1382(e)(4)(A) of this title.

(VI) The Commissioner must determine whether payment to the person was previously stopped under subparagraph (A)(iii), whether the person's payee designation was revoked under section 1007(a), or whether certification of payment to the person was revoked under section 405(j), because the person misused benefits under subchapter II, VIII, or this subchapter.

(VII) The Commissioner must determine whether the person was convicted, and not later exonerated, under Federal or State law of one of the felonies listed in clause (xv), or of trying or conspiring to commit one.

(iii) Benefits may not be paid to a proposed payee if any of these conditions applies: (I) the person was previously convicted as described in clause (ii)(III); (II) except as allowed by clause (iv), payment to the person was previously stopped, the designation was revoked under section 1007(a), or certification was revoked under section 405(j) because of misuse; (III) except as allowed by clause (v), the person is a creditor who provides the beneficiary goods or services for payment; (IV) the person was previously convicted of another offense described in clause (ii)(IV), unless the Commissioner finds payment appropriate despite the conviction; (V) the person is described in section 1382(e)(4)(A); (VI) except as allowed by clause (xvii), the person was previously convicted, and not later exonerated, of a felony described in clause (ii)(VII); or (VII) the person's own benefits under this subchapter, subchapter II, or subchapter VIII are being paid to a representative payee during the period in which the beneficiary's benefits would be paid to that person.

(iv) Regulations must allow the Commissioner to exempt a person from clause (iii)(II), one case at a time, when the exemption is in the best interest of the person or spouse whose benefits would be paid to that person.

(v) The creditor restriction in clause (iii)(III) does not apply to: (I) a relative living in the beneficiary's household; (II) the beneficiary's legal guardian or legal representative; (III) a facility licensed or certified under State or local law as a care facility; (IV) an administrator^*, owner^*, or employee of such a facility when the beneficiary lives there and the local Social Security office has first made good-faith efforts to find another payee that would better serve the beneficiary; or (V) a person whom the Commissioner finds acceptable in written findings under regulatory procedures.

(vi) To be accepted under clause (v)(V), a proposed payee must satisfy the Commissioner that the person poses no risk to the beneficiary, has no substantial conflict of interest from the financial relationship with the beneficiary, and that no more suitable payee can be found.

(vii) For a person described in subparagraph (A)(ii)(II), preference in choosing a payee must go to: (I) a certified community-based nonprofit social-service agency; (II) a Federal, State, or local agency whose mission involves income maintenance, social services, or health care; (III) a State or local agency with fiduciary duties; or (IV) an appropriate designee of one of those non-Federal agencies. This preference does not apply when the Commissioner decides a family member would be appropriate.

(viii) If the Commissioner decides a representative payee is needed and that paying the benefit directly would cause substantial harm, the Commissioner may defer direct payment for an initial entitlement or suspend it for an existing entitlement until a payee is selected.

(ix) The deferral or suspension normally may last no more than one month. This one-month limit does not apply when the person or spouse is legally incompetent, is under 15, or is a person described in subparagraph (A)(ii)(II).

(x) Benefits held while a payee is being selected must be paid to the person or, after selection, to the payee, either as one payment or over a period the Commissioner finds best for the person.

(xi) A person who disagrees with requiring a representative payee or with choosing a particular payee has a right to a Commissioner hearing and judicial review to the same extent provided in subsection (c).

(xii) Before the first payment to a representative payee, the Commissioner must give written notice of the initial decision. The notice goes to the person, except that it goes only to the legal guardian or legal representative when the person is under 15, is an unemancipated minor under 18, or is legally incompetent.

(xiii) The notice must be clear and easy to understand. It must identify the proposed payee and explain the right to appeal both the need for a payee and the choice of payee, and the right to inspect the supporting evidence and submit more evidence.

(xiv) Despite the Privacy Act and other Federal or State law, except section 6103 of the Internal Revenue Code and section 1306(c) of this title, the Commissioner must give a Federal, State, or local law-enforcement officer, on written request, the current address, Social Security account number, and photograph, if applicable, of a person investigated under this subparagraph. The officer must provide the person's name and reasonably required identifying information, and must tell the Commissioner that the person is described in section 1382(e)(4)(A), that the officer needs the information for official duties, and that locating or arresting the person is part of those duties.

(xv) The felonies covered by clause (ii)(VII) are: human trafficking, including sections 1590 and 1591 of title 18; false imprisonment, including section 1201; kidnapping, including section 1201; rape and sexual assault, including sections 2241 through 2244; first-degree homicide, including section 1111; robbery, including section 2111; fraud to obtain government assistance, including sections 287, 1001, and 1343; fraud by scheme, including section 1343; theft of government funds or property, including section 641; abuse or neglect, including sections 111, 113 through 117; forgery, including section 642 and chapter 25 except section 512; and identity theft or identity fraud, including sections 1028 and 1028A. The Commissioner may add felony crimes by regulation.

(xvi) To perform the required investigation, the Commissioner may run a background check on anyone seeking to be a payee and may disqualify a person who will not permit it. The Commissioner may revoke, for a payee serving on or after January 1, 2019, certification of benefit payments to a person who will not permit the check.

(xvii) Clause (ii)(VII) does not apply to a person described below, and the Commissioner may exempt such a person from clause (iii)(VI) when that is in the beneficiary's best interest. The person must be the custodial parent of a minor child^*, the custodial spouse of the beneficiary, the custodial parent of a beneficiary whose disability began before age 22, the court-appointed custodial guardian, the custodial grandparent of a minor grandchild, a parent who was the payee for a minor child who turned 18 and remains eligible, or a person who received a Presidential or gubernatorial pardon for the relevant conviction.

(C)(i) When a representative payee receives benefits for a person or spouse, the Commissioner must create an accountability-monitoring system. The payee must report at least once a year how the money was used. The Commissioner must use statistically valid procedures to review reports and find improper use.

(ii) The annual-report rule does not apply to a State institution. Instead, the Commissioner must monitor institutions in each State.

(iii) The annual-report rule does not apply when a person entitled to payment lives in a Federal institution and that institution is the payee.

(iv)(I) The annual-report rule does not apply when the payee is a parent or legal guardian of a minor beneficiary who mainly lives in the same household, a parent of a disabled beneficiary who mainly lives in the same household, or the beneficiary's spouse. (II) The Commissioner must establish procedures and regulations to decide whether these people qualify for the exemption.

(v) Despite these exemptions, the Commissioner may require a report at any time when there is reason to believe the payee is misusing the money.

(vi) If a person required to report does not submit the report, the Commissioner may, after notifying that person and the beneficiary, require the person to appear in person at the Social Security field office serving the beneficiary's area to receive the payments.

(D)(i) A qualified organization may collect a monthly fee for its expenses, including overhead, when it serves as a representative payee. The fee cannot be more than the lesser of 10 percent of the monthly benefit or $25 per month. The $25 amount is $50 per month when the individual has an alcoholism or drug-addiction condition and cannot manage benefits under subparagraph (A)(ii)(II). The organization cannot collect a fee for a month in which the Commissioner or a court finds that the organization misused all or part of the benefit. Any fee collected for that month is treated as a misused part of the benefit under subparagraphs (E) and (F). After 1995, the Commissioner must adjust each dollar amount in the second limit every year, using the same method and to the same extent used to adjust benefits under section 415(i)(2)(A)(ii), except that a result that is not a whole dollar is rounded to the nearest whole dollar. Any agreement for a fee above the permitted amount is void and is treated as misuse by the organization.

(ii) “Qualified organization” means any State or local government agency whose mission is income maintenance, social services, or health-care activities; any State or local government agency with fiduciary responsibilities; or a certified community-based nonprofit social-service agency (defined in subparagraph (I)). The agency must, under the Commissioner’s regulations, regularly provide representative-payee services at the same time to at least five individuals under this paragraph, section 405(j)(4), or section 1007. It must also show the Commissioner that it is not otherwise a creditor of any such individual. The Commissioner must make regulations allowing a case-by-case exception to the creditor requirement when the exception is in that individual’s best interest.

(iii) A qualified organization that knowingly charges or collects, directly or indirectly, more than the maximum fee, or agrees to do so, may be fined under title 18, imprisoned for up to six months, or both.

(iv) If an individual is no longer eligible for benefits but still has unpaid past-due benefits, each amount of those past-due benefits payable in a month is treated, for clause (i), as that month’s monthly benefit.

(E) Restitution. If the Commissioner’s negligent failure to investigate or monitor a representative payee results in misuse of benefits, the Commissioner must pay the beneficiary or the beneficiary’s representative payee an amount equal to the misused benefits. The same payment rule applies when the representative payee that misuses all or part of a benefit is not an individual, whether or not it is a “qualified organization,” or is an individual who served 15 or more beneficiaries under this subchapter, subchapter II, subchapter VIII, or any combination of them during any month in the period of misuse. The Commissioner must pay the beneficiary or an alternative representative payee an amount equal to the benefit misused. This rule is subject to the limitation in subparagraph (H)(ii). The Commissioner must make a good-faith effort to obtain restitution from the representative payee whose appointment was ended.

(F)(i)(I) A representative payee for an eligible individual under 18 must establish a financial-institution account for that individual when the individual is entitled to the benefits described in subclause (II), deposit those benefits into the account, and maintain the account for the uses in clause (ii). (II) These are past-due monthly benefits under this subchapter, including federally administered State supplementary payments under an agreement under section 1382e or section 212(b) of Public Law 93–66, that remain after withholding for interim-assistance reimbursement under subsection (g) and attorney fees under subsection (d)(2)(B), and that exceed six times the maximum monthly benefit payable to an eligible individual.

(ii)(I) The payee must use the account for allowable expenses. (II) Allowable expenses are education or job-skills training; personal-needs assistance; special equipment; housing modification; medical treatment^*; therapy or rehabilitation; or another item or service the Commissioner finds appropriate. The expense must benefit the individual, and an expense for personal-needs assistance, special equipment, housing modification, therapy or rehabilitation, or another item or service must relate to the individual’s impairment or combination of impairments. (III) Using account funds in an unauthorized way is a misapplication for all purposes of this paragraph. A payee who knowingly misapplies funds is liable to the Commissioner for the total amount misapplied. If an eligible individual who is the individual’s own payee knowingly misapplies funds, the Commissioner must reduce that individual’s future benefits, or the future benefits of that individual and spouse, by the total amount misapplied. (IV) This account rule continues to apply to the funds after the child turns 18, whether benefits are paid directly or through a payee.

(iii) The payee may also deposit other past-due benefits under this subchapter if those benefits equal or exceed the maximum monthly benefit payable to an eligible individual, including the specified State supplementary payments.

(iv) The Commissioner must establish accountability monitoring under which the payee reports, at the time and in the manner the Commissioner requires, on activity involving the account.

(G)(i) In addition to other reviews, the Commissioner must provide periodic onsite reviews of a person or agency receiving benefits for another individual as representative payee under this paragraph, section 405(j), or section 1007 when the payee serves 15 or more individuals; is a certified community-based nonprofit social-service agency; or is another agency serving 50 or more individuals.

(ii) Within 120 days after each fiscal year ends, the Commissioner must report to the House Ways and Means Committee and the Senate Finance Committee on the onsite reviews and other representative-payee reviews during that year. The report must describe problems and corrective action, and include the number and results of reviews; the number of changed payees and the reasons; the number of cases with expedited, targeted oversight after an allegation of misuse, failure to pay a vendor, or a similar irregularity; the number of discovered misuse cases; how the Commissioner handled them; their final disposition, including criminal penalties; and other information the Commissioner considers appropriate.

(H)(i) If the Commissioner or a court finds that a representative payee other than a Federal, State, or local government agency misused all or part of a benefit, that payee is liable for the misused amount. Any unpaid amount is treated as an overpayment to the payee for recovery under this chapter and related laws. Subject to clause (ii), when the Commissioner recovers all or part of it, the Commissioner must pay the recovered amount to the individual or an alternative payee. (ii) The payment under this clause plus the payment under subparagraph (E) cannot exceed the total benefit amount misused for that individual.

(I) “Certified community-based nonprofit social-service agency” means a community-based nonprofit social-service agency that meets regulations requiring annual certification to the Commissioner that it is bonded as the Commissioner requires and licensed in every State where it serves as a representative payee, if licensing is available there. Each annual certification must include a copy of any independent audit of the agency performed since the previous certification.

(3) The Commissioner may establish by regulation ranges of income within which one benefit amount applies.

(4)(A) The Commissioner may give an applicant who appears eligible for the next month and faces a financial emergency a cash advance against benefits, including federally administered State supplementary payments. The advance cannot exceed the amount payable for the first month to an eligible individual with no other income and must be repaid through proportional reductions over no more than six months. (B) The Commissioner may pay up to six months of benefits before deciding disability or blindness when the applicant appears disabled or blind. Those payments are not overpayments merely because the applicant is later found not disabled or blind.

(5) Benefits based only on age, blindness, or disability continue through the second month after the month in which blindness or disability ends, if the individual remains otherwise eligible.

(6) Benefits cannot be stopped or suspended solely because the blindness or impairment supporting eligibility ended or may have ended when the individual is in the Ticket to Work and Self-Sufficiency Program or another approved rehabilitation, employment, or support program, and the Commissioner finds that continuing or completing it for a specified time will increase the chance that the individual will permanently leave the blindness or disability rolls.

(7)(A) If an impairment is found to have ended, never existed, or no longer be disabling, and the individual timely asks for review or a hearing, the individual may elect under regulations to keep receiving benefits. Payments begin with the first month after October 9, 1984, for which benefits would otherwise stop, and end with the earlier of the month before the hearing decision or the month before no review or hearing request remains pending. (B) If the final decision affirms termination, the continued payments are overpayments for all purposes. If the Commissioner finds the appeal was made in good faith, all of those payments must be considered for waiver under subsection (b)(1). (C) This rule applies to determinations made on or after October 9, 1984, and to earlier determinations based on a timely review or hearing request.

(8)(A) If an administrative law judge finds after a subsection (c) hearing that an individual is entitled to disability or blindness benefits, and the Commissioner has not issued a final decision within 110 days, current benefits must be paid for months beginning when the 110 days expire and ending when the final decision is issued. (B) Delay caused without good cause by the individual or representative is excluded only to the extent it exceeds 20 calendar days. (C) These payments are not overpayments unless obtained by fraud.

(9) Benefits cannot be denied solely because an individual refuses compensation offered for a crime of which the individual was a victim.

(10) If remaining past-due monthly benefits, after interim-assistance reimbursement and attorney fees under subsection (d)(2)(B), equal or exceed three times the maximum monthly benefit for an eligible individual or couple, the remaining amount must be paid in installments. There may be no more than three installments, six months apart. Each of the first two normally cannot exceed that three-times amount. The limit may be exceeded for unpaid food, clothing, shelter, or medically necessary care, supplies, equipment, or medicine, or for current or near-term medically necessary expenses or buying a home, when the amount will not be reimbursed by a public-assistance program, Medicare, Medicaid, or a legally liable private entity. This paragraph does not apply to an individual expected to die from a medically determinable impairment within 12 months or whom the Commissioner expects to remain ineligible for the next 12 months. Here, “benefits” includes federally administered State supplementary payments and payments under section 212(b) of Public Law 93–66.

(b) Overpayments and underpayments; adjustment, recovery, or payment of amounts by Commissioner

(1)(A) When the Commissioner finds that too much or too little was paid for a person, the Commissioner must correct it, subject to this subsection, by adjusting future payments, recovering money from the person, eligible spouse, or either estate, or paying the amount owed to the person or spouse. If the person died, payment may go to a surviving spouse, whether or not an eligible spouse, if they lived together at death or during the preceding six months. If the person was a disabled or blind child living with a parent, payment may go to that parent or parents.

(B) For an overpayment, the Commissioner must avoid penalizing a person or eligible spouse who was not at fault when recovery would defeat this subchapter's purposes, be against equity and good conscience, or be inefficient because the amount is small. For a person or spouse receiving monthly benefits, recovery in a month may not exceed the lesser of that month's benefit or 10 percent of that month's income, including the benefit but excluding subchapter II payments recovered through section 1320b–17 and income excluded under section 1382a(b). For a lump sum, the Commissioner must recover at least the lesser of the overpayment or lump sum, unless fraud, intentional misrepresentation, or hiding material information was involved, or the person requests another rate and the Commissioner finds it justified. A limited-rate recovery option does not prevent greater relief under the preceding rule. To decide whether recovery would defeat the subchapter's purpose, the Commissioner must require authorization to obtain needed financial records from a financial institution, subject to the Right to Financial Privacy Act's cost rules and the conditions in subsection (e)(1)(B).

(2) If an overpayment is made after a person dies by direct deposit into a joint account held by the deceased and the surviving spouse, and the spouse was eligible for a payment for the death month, the excess is treated as an overpayment to the spouse. If an overpayment is paid after death to a representative payee for the person, the payee is liable, and the Commissioner must record the overpayment under the payee's Social Security number.

(3)(A) If an overpayment is made for a month when a represented minor beneficiary is in State foster care and the State is payee, the State is liable. The United States^* may not adjust payments to or recover from the child. (B) “Represented minor beneficiary” means a child, as section 675(8) defines that term, who is entitled to benefits for the month and whose benefits are certified to a payee. This section does not define “child.”

(4) If an overpayment is caused only by resources exceeding the applicable limit by $50 or less, the person and spouse are treated as not at fault. No adjustment or recovery is made unless the Commissioner finds that the incorrect or late report of the resources was knowing and willful.

(5) For a delinquent amount, the Commissioner may use the collection methods in sections 3711(f), 3716, 3717, and 3718 of title 31 and section 5514 of title 5, as those provisions stood immediately after April 26, 1996. “Delinquent amount” means an amount over the correct payment, paid to a person after age 18, that regulations determine otherwise cannot be recovered after the person stops being a beneficiary.

(6) Adjustments caused by a retroactive subchapter II payment are governed by section 1320a–6.

(7) Cross-program recovery of overpayments is governed by section 1320b–17.

(8)(A) When the correction is an underpayment, no payment may be made under this subsection for a period when the person is ineligible because the person is an inmate of a jail, prison, or other penal or correctional institution described in section 402(x)(1)(A)(ii) or (iii), or is ineligible under section 1382(e)(4), until the person is no longer ineligible. (B) This does not limit the Commissioner's power to withhold, adjust, or recover amounts otherwise due under this subchapter, subchapter II, or VIII that would have been deducted from a payment but for subparagraph (A).

(c) Hearing to determine eligibility or amount of benefits; subsequent application; time within which to request hearing; time for determinations of Commissioner pursuant to hearing

(1)(A) The Commissioner must make findings of fact and decisions about the rights of each person applying for payment under this subchapter. An unfavorable disability decision must contain an understandable statement of the case discussing the evidence and stating the Commissioner’s decision and reasons. The Commissioner must give a person who is or claims to be an eligible individual or spouse reasonable notice and an opportunity for a hearing about a disagreement over eligibility or benefit amount if the person requests the hearing within 60 days after receiving notice. Based on the evidence at the hearing, the Commissioner must affirm, change, or reverse the findings and decision. The Commissioner may also hold hearings and conduct investigations and other proceedings on the Commissioner’s own motion when necessary or proper to administer this subchapter. In any hearing, investigation, or proceeding, the Commissioner may administer oaths and affirmations, examine witnesses, and receive evidence, including evidence that court evidence rules would exclude. When deciding good faith, fault, fraud, deception, or intent, the Commissioner must specifically consider the person’s physical, mental, educational, and linguistic limitations, including limited English ability.

(B)(i) A late request to review an initial adverse determination, or an adverse reconsideration determination, cannot by itself support denying a later application if the applicant shows that the applicant or another person described in subparagraph (A) failed to request review while relying in good faith on incorrect, incomplete, or misleading information from a Social Security Administration^* officer or employee, or a State agency acting under section 421. The information must concern what happens if the person reapplies instead of requesting review. (ii) Every notice of an adverse determination that may be reviewed under subparagraph (A) must clearly and specifically explain how choosing to reapply instead of requesting review can affect possible eligibility for payments.

(2) Except when the disagreement concerns disability as defined in section 1382c(a)(3), the hearing determination must be made within 90 days after the person requests the hearing.

(3) The Commissioner’s final determination after a hearing is subject to judicial review under section 405(g), to the same extent as the Commissioner’s final determinations under section 405.

(d) Procedures applicable; prohibition on assignment of payments; representation of claimants; maximum fees; penalties for violations

(1) Section 407 and subsections (a), (d), and (e) of section 405 apply to this part to the same extent as they apply to subchapter II.

(2)(A) Section 406 applies to this part to the same extent as to subchapter II, except that subsections 406(a)(4) and 406(d) do not apply. In applying section 406: (i) in 406(a)(2)(A)(ii)(I) and (D)(i), use the phrase “as determined before any applicable reduction under section 1383(g), and reduced by any reduction under this subchapter or subchapter II under section 1320a–6(a)” in place of the stated parenthetical; (ii) in 406(a)(2)(B) and 406(b)(1)(B)(i), use “paragraph (7)(A) or (8)(A) of section 1383(a) or the requirements of due process of law” in place of “subsection (g) or (h) of section 423”; (iii) in 406(a)(2)(C)(i), use “under subchapter II” in place of “under subchapter XVI”; (iv) in 406(b)(1)(A), use “pay the amount of such fee” in place of “certify the amount of such fee for payment,” and remove “or certified for payment”; (v) in 406(b)(1)(B)(ii), use “deemed to be such amounts as determined before any applicable reduction under section 1383(g), and reduced by any reduction under this subchapter or subchapter II under section 1320a–6(a)” in place of the specified parenthetical; and (vi) in 406(e)(1), use “subparagraphs (B) and (C) of section 1383(d)(2)” in place of “the preceding provisions of this section,” and use “subchapter XVI” in place of “this subchapter.”

(B) If a claimant is entitled to past-due benefits and an attorney represents the claimant, the Commissioner must pay the attorney from those benefits the lesser of the part of the maximum fee that does not exceed 25 percent of past-due benefits, calculated before the section 1383(g) reduction and reduced by reductions under this subchapter or subchapter II under section 1320a–6(a), or the past-due benefits available after reductions under section 1383(g) and section 1320a–6(a).

(C)(i) Whenever an attorney’s fee must be paid from past-due benefits, the Commissioner must assess the attorney. (ii)(I) The assessment equals the fee required before assessment multiplied by the necessary recovery rate, but cannot exceed $75. After the 2003 amendments take effect, the $75 amount, including any previously adjusted amount, is adjusted annually under the benefit-adjustment procedures in section 415(i)(2)(A)(ii), using the higher of $75 or the amount that would have applied for the preceding December before rounding. A result that is not a whole dollar is rounded down, but never below $75. (II) The rate must be enough to recover fully the costs of determining and approving the fees, but cannot exceed 6.3 percent. (iii) The Commissioner may collect the assessment by offsetting it against the attorney’s fee. (iv) The attorney cannot seek or obtain reimbursement from the claimant. (v) The assessments go into the Treasury’s general fund as miscellaneous receipts. (vi) They may be collected and used only to the extent and in the amount provided in advance in appropriations Acts. Appropriated amounts may remain available until spent for administrative expenses under this subchapter and related laws.

(D) With the notice of an adverse determination, the Commissioner must notify each claimant in writing about options for obtaining an attorney to present the case and about free legal-services organizations available to qualifying claimants.

(e) Administrative requirements prescribed by Commissioner; criteria; reduction of benefits to individual for noncompliance with requirements; payment to homeless

(1)(A) Subject to subparagraph (B) and subsection (j), the Commissioner must set requirements for applications, suspension or termination of assistance, other information and materials, and reports of events and changes needed to administer this subchapter effectively and efficiently. (B)(i) Eligibility cannot be decided only from an applicant’s declarations. Relevant information must be checked with independent or collateral sources, and more information obtained as needed, so benefits go only to eligible individuals or spouses and are paid in the correct amounts. For this purpose and federally administered State supplementary payments, the Commissioner must request and use information available under section 6103(l)(7) of the Internal Revenue Code and State-system information under section 1320b–7, and must follow the requirements that apply to States under section 1320b–7(a)(6) and (c).

(ii)(I) The Commissioner may require an applicant, recipient, or another person whose income or resources matter to authorize access to needed financial records held by a financial institution, subject to the Right to Financial Privacy Act’s cost-reimbursement rule. (II) The authorization remains effective until the earliest of a final adverse decision on the application, the recipient’s eligibility ending, or written revocation. (III) The authorization satisfies the cited Right to Financial Privacy Act requirements: it need not be given to the institution, its certification requirement does not apply, and a request under it is deemed to satisfy the specified request requirements. (IV) The Commissioner must tell the person the authorization’s duration and scope. (V) If the person refuses or revokes the authorization, the Commissioner may find the applicant or recipient ineligible, find that recovery of an overpayment would not defeat this subchapter’s purpose, or both.

(iii)(I) The Commissioner may require an applicant, recipient, legal guardian, or another person whose income or resources matter to authorize access to needed records held by a “payroll data provider” (a term defined in section 1320e–3(c)(1)). (II) This authorization remains effective until the earliest of a final adverse decision, the recipient’s eligibility ending, written revocation, or the end of the basis for counting another person’s income and resources. (III) The Commissioner need not give the authorization to the payroll data provider. (IV) The Commissioner must tell the person its duration and scope. (V) If the required authorization is refused or revoked, paragraphs (2)(B) and (10) do not apply beginning on the first day of the first month in which that occurs.

(C) For determinations under section 1382(e), an administrator of a nursing home, extended-care facility, or intermediate-care facility must report an eligible individual’s or spouse’s admission to the Commissioner within two weeks.

(2)(A) For the first failure or delay in a required report, the Commissioner must reduce later benefits by $25; for the second, by $50; and for the third or later, by $100, unless the individual was without fault or had good cause. (B) Good cause must be found when the individual or another person whose authorization is material authorized access to payroll records and the event was a change of employer.

(3) The Commissioner must provide a way to pay an eligible individual who has no permanent dwelling, fixed home, or mailing address.

(4) An English translation by a third party of a foreign-language statement is not reliable under this subchapter unless the translator, under penalty of perjury, certifies that it is accurate and discloses the nature and scope of the relationship with the applicant or recipient.

(5) If an individual failed to apply by a date because a Social Security officer or employee gave misinformation about eligibility, the individual is deemed to have applied on the later of the misinformation date or the date all entitlement requirements other than filing an application were met.

(6) If an individual visits a Social Security field office because of a notice with a response deadline, or because a benefit payment was stolen, lost, or not received, the Commissioner must ensure a face-to-face interview with an officer or employee before the office closes that day.

(7) The Commissioner must immediately redetermine eligibility when there is reason to believe fraud or “similar fault” was involved in the application, unless a United States attorney or equivalent State prosecutor certifies in writing that doing so would substantially risk a related criminal prosecution. The Commissioner must disregard evidence reasonably believed to involve fraud or similar fault. “Similar fault” means knowingly making an incorrect or incomplete material statement or knowingly concealing material information. If the redetermination leaves insufficient evidence of eligibility, the Commissioner may end eligibility and treat benefits based on that evidence as overpayments.

(8) The Commissioner must request relevant medical, identification, and employment information about an alien applicant from the Immigration and Naturalization Service or the Centers for Disease Control. The Commissioner may decide the case before receiving it.

(9) At least four times each year and when the Immigration and Naturalization Service requests it, the Commissioner must give that Service the name, address, and other identifying information of anyone the Commissioner knows is not lawfully present in the United States. Agreements with States must require the States to provide the same information at the required times about anyone they know is not lawfully present.

(10) An individual who authorized access to payroll-provider records, or for whom another material person gave that authorization, is not subject to a penalty under section 1320a–8a for an omission or error concerning wages as reported by the payroll data provider.

(f) Furnishing of information by Federal agencies

The head of each Federal agency must provide information the Commissioner needs to decide eligibility or benefit amount, or to verify other information related to those decisions.

(g) Reimbursement to States for interim assistance payments

(1) If a State or local government paid interim assistance to a person while the person awaited a decision on benefits, the Commissioner may, with the person's written authorization, withhold benefits payable for that person and pay the State or local government the reimbursable amount. The amount is limited to the interim assistance the State or local government actually provided during the period and to the amount authorized by this subsection.

(2) The Commissioner may make the payment from an initial award, a later award, or an underpayment, subject to the conditions in this subsection and the person's authorization.

(3) “Interim assistance” means assistance paid by a State or political subdivision to an individual while an application or appeal for benefits under this subchapter or section 1382h was pending, when the assistance would have been terminated or suspended if the person had later been found eligible. This section does not otherwise define “interim assistance.”

(4) A State may receive reimbursement only if it has an agreement with the Commissioner providing that: (A) when the Commissioner pays more than the authorized reimbursable amount, the State or political subdivision will pay the excess to the person as quickly as possible and within 10 working days or a shorter agreed period; and (B) the State will follow other rules needed for efficient administration, including protection of hearing rights for a person harmed by State action under this subsection.

(5) Subsection (c) does not apply to a disagreement about the Commissioner's payment to a State under this subsection or the amount the State or political subdivision kept.

(h) Payment of certain travel expenses

The Commissioner must pay travel expenses, on an actual-cost or fixed(commuted)-cost basis, for a person's travel to a medical examination requested for a disability determination. The Commissioner must also pay travel within the United States for parties, representatives, and reasonably necessary witnesses attending reconsideration interviews or administrative-law-judge proceedings about a determination under this subchapter. Air travel is limited to coach fare unless first class is required by the person's health or no alternative accommodation is available under regulations. Other travel is limited to the cost of the most economical and prompt transportation suitable for the person's health. A representative's travel payment for an administrative proceeding may not exceed the maximum allowed for travel beginning within the geographic area served by the office with jurisdiction.

(i) Unnegotiated checks; notice to Commissioner; payment to States; notice to States; investigation of payees

(1) Each month the Treasury Secretary^* must tell the Commissioner about benefit checks that include State supplementary payments and were not presented for payment within 180 days after issuance.

(2) The Commissioner must periodically calculate the total State-supplement amount included in those unpresented checks and pay, or credit, each State its share. Amounts not paid to States must be returned to the appropriation from which they were paid.

(3) After receiving the Treasury notice, the Commissioner must tell each State with the relevant agreement about checks issued under that State's agreement that were not presented within 180 days.

(4) To the greatest feasible extent, the Commissioner must investigate the whereabouts and eligibility of people whose checks were not presented within 180 days.

(j) Application and review requirements for certain individuals

(1) A person who was eligible under section 1382 or 1382h, but then was ineligible under both for 12 consecutive months, may not become eligible again under either section until the person reapplies under section 1382 and is found eligible, or requests and is found eligible for reinstatement under subsection (p). For a person whose ineligibility resulted from being called to active duty under the listed provisions of titles 10 or 32, the period is 24 consecutive months.

(2)(A) A person previously eligible under section 1382h(b) is subject to a prompt review of the type described in section 1382c(a)(4) when the person again becomes eligible on the basis of the same impairment, after a period of ineligibility, and has earned income, excluding income excluded by section 1382a(b), at or above the amount that would have made the person ineligible for section 1382(b) payments. This applies whether the renewed eligibility is under section 1382 or 1382h(a), and also when the renewed eligibility is under section 1382h(b), with the income test covering the month of renewed eligibility or any of the preceding 12 months as specified in the statute.

(B) If the review finds that the impairment ended, never existed, or is not disabling, the person may not again become eligible under section 1382 or 1382h until the person reapplies under section 1382 and is found eligible.

(k) Notifications to applicants and recipients

The Commissioner must tell a person receiving benefits under section 1382 because of disability or blindness about possible eligibility under section 1382h when the person is first awarded benefits, if the person is at least 18, and at the earliest time after the award when the person's monthly earned income, excluding income excluded under section 1382a(b), reaches $200 or more. The Commissioner must repeat the notice periodically while that level of earned income continues.

(l) Special notice to blind individuals with respect to hearings and other official actions

(1) A blind person applying for or receiving benefits who is entitled to notice of a decision, determination, or other action may choose one additional way to receive it: (A) a telephone notice within five working days after the mailed notice; (B) the mailed notice as a certified letter; or (C) an alternative procedure established by the Commissioner and agreed to by the person.

(2) The choice may be made at any time. An opportunity must be given at application to every blind applicant and at each eligibility redetermination to every blind recipient. Once made, the choice applies to all later notices under this subchapter until the person changes or withdraws it.

(m) Pre-release procedures for institutionalized persons

The Commissioner must create a system allowing a person to apply for supplemental security income before being discharged or released from a public institution.

(n) Concurrent SSI and supplemental nutrition assistance applications by institutionalized individuals

The Commissioner and the Secretary of Agriculture must create a procedure allowing a person applying for supplemental security income to apply at the same time for the Supplemental Nutrition Assistance Program under the Food and Nutrition Act of 2008.

(o) Notice requirements

The Commissioner must take the steps needed to ensure that every notice issued under this subchapter by the Commissioner or a State agency is written in simple, clear language and gives the address and telephone number of the local Social Security Administration office serving the recipient. If a local office did not create the notice, it is enough for the notice to give that office's address and a telephone number through which the office can be reached.

(p) Reinstatement of eligibility on the basis of blindness or disability

(1)(A) The Commissioner must reinstate benefits when an eligible person described in subparagraph (B) files a qualifying reinstatement request during the period in subparagraph (C). Reinstatement follows this subsection.

(B) The person must have been eligible, before the request month, because of blindness or disability based on an application and then lost eligibility because of earned income, or earned and unearned income, for at least 12 consecutive months. The person must now be blind or disabled because of the same or a related impairment, the blindness or disability must prevent substantial gainful activity, and the person must meet the nonmedical eligibility requirements.

(C) The filing period is normally the 60 consecutive months beginning with the month after the most recent month of eligibility before the income-based ineligibility period. The Commissioner may extend it when the person had good cause for filing late.

(2)(A) The request must use the form and information the Commissioner requires. It must expressly state that the person meets the same-or-related impairment, inability-to-work, and nonmedical requirements in paragraph (1)(B). (B) If the Commissioner finds that the person is not eligible for reinstatement, the request may count as an application for benefits.

(3) In deciding whether the person meets the impairment requirement, the rules in section 1382c(a)(4) apply.

(4)(A) Reinstated eligibility begins with the benefit for the month after the request month. (B) The amount is determined under this subchapter, but is reduced by any provisional benefit paid for that month under paragraph (7). (C) Unless this subsection says otherwise, reinstated eligibility has the same terms and conditions as eligibility established by an application.

(5) When a person's eligibility is reinstated, the spouse's eligibility is also reinstated if the spouse was previously an eligible spouse and the Commissioner finds that the spouse meets every requirement except filing an application. Paragraph (4) applies to the spouse.

(6) After benefits have been payable under this subsection for 24 months, whether consecutive or not, the person is treated, for paragraph (1)(B)(i)(I), as eligible based on an application.

(7)(A) A person described in paragraph (1)(B) who properly files a request is eligible for provisional benefits unless the Commissioner finds that the person does not meet the prior-eligibility requirement or made a false declaration. That finding is final and cannot be reviewed under subsection (c)(1) or (3).

(B)(i) A provisional benefit normally equals the monthly amount payable to an eligible person with the same kind and amount of income. (ii) If the person has a previously eligible spouse who meets all section 1382c(b) requirements except applying, the provisional amount equals the amount payable to an eligible person and spouse with the same income.

(C) Provisional benefits begin the month after the request month. They end at the earliest of: (I) the month the Commissioner decides reinstated eligibility; (II) the fifth month after the first month for which provisional benefits were payable; or (III) the month the Commissioner finds that the person lacks the prior eligibility or made a false declaration.

(D) If reinstatement is denied, provisional benefits are not recoverable as overpayments unless the Commissioner finds that the person knew or should have known that the person did not meet paragraph (1)(B).

(8) For this subsection other than paragraph (7), “benefits under this subchapter” includes State supplementary payments made under section 1382e(a) or section 212(b) of Public Law 93–66. This section does not define “benefits under this subchapter.”