404.1287 limitation. Allowance of a credit or refund. 404.1290 Secretary defined. Subpart N Benefits in Case of Veterans 404.1301 General effect of section 217 of the Act. 404.1302 "World War II" period defined. 404.1303 "Post-World War II" period defined. 404.1304 "World War II veterans" defined. 404.1305 "Veteran of post-World War II service" defined. 404.1306 "Active service of 90 days" defined. 404.1307 "Separation under conditions other than dishonorable" defined. 404.1308 Effect of section 217(a) of the Act. 404.1309 Effect of section 217(e) of the Act. 404.1310 Limitation on granting of World War II and post-World War II service wage credits. 404.1311 "Federal benefit" defined. Sec. 404.1312 404.1313 Determination and certification of payments based on World War II or post-World War II service wage credits. Effect of notice of determination that a "Federal benefit" is payable. 404.1314 Erroneous payment resulting from a determination that a "Federal benefit" has been determined payable. 404.1315 Effect of section 217(b) of the Act; deemed insured status and deemed wages provided. 404.1316 Conditions barring application of deemed insured status. 404.1317 Computation of benefits based on deemed insured status. 404.1318 Benefits payable under deemed insured status upon death of World War II veteran. 404.1319 Determination of benefits payable on deemed insured status and certification of payments. 404.1320 Effect on determination and certification of payment under deemed insured status of receipt of notice of determination that pension or compensation is payable by Veterans' Administration. Determinations of disability. Initial determinations as to entitlement or termination of entitlement. 404.1522 Reconsideration, hearing and review. 404.1523 Evidence of disability. 404.1524 Medical evidence. 404.1525 404.1526 404.1527 404.1528 404.1529 404.1530 404.1531 404.1532 404.1533 Determination of disability by nongovernmental organization or other governmental agency. Conclusion by physician regarding individual's disability. Consultative examinations. Evidence of continuation of disability. Place and manner of submitting evidence. Failure to submit evidence. Evaluation of work activities. 404.1534 Evaluation of earnings from work. Limitations on eligibility to period of trial work. 404.1538 Recovery from impairment while working. 404.1539 Cessation of disability. Appendix-Listing of impairments Subpart Q-Representative Payee 404.1601 Payments on behalf of an individual. 404.1602 Submission of evidence by representative payee. 404.1803 Responsibility of payee. representative 404.1610 Transfer of accumulated benefit payments. AUTHORITY: The provisions of this Part 404 issued under secs. 205, 227, and 1102, 53 Stat. 1368, as amended, 79 Stat. 379, 49 Stat. 647, as amended; section 5 of the Reorganization Plan No. 1 of 1953, 67 Stat. 18, 631; 42 U.S.C. 405, 427, and 1302, unless otherwise noted. Subpart A-Introduction, General Definitions and General Provisions § 404.1 Introduction. The regulations in this Part 404 (Regulations No. 4 of the Social Security Administration) relate to the provisions of Title II of the Social Security Act as amended on August 28, 1950, and as further amended thereafter. The regulations in this part are divided into seventeen subparts: (a) Subpart A contains provisions relating to general definitions and use of terms. (b) Subpart B relates to quarters of coverage and insured status requirements. (c) Subpart C relates to basic computation, recomputation, and recalculation of benefits and lump sums. (d) Subpart D relates to the requirements for entitlement to monthly benefits and to the lump-sum death payment, duration of entitlement and benefit rates. (e) Subpart E contains provisions relating to the reduction and increase of insurance benefits and to deductions from benefits and lump-sum death payments. (f) Subpart F relates to overpayments, underpayments, waiver of adjustment or recovery of overpayments and liability of certifying officers. (g) Subpart G relates to filing of applications and other forms. (h) Subpart H relates to evidentiary requirements for establishing an initial and continuing right to monthly benefits and for establishing a right to lump-sum death payment. (Evidentiary requirements relating to disability are contained in Subpart P.) (i) Subpart I relates to maintenance and revision of records of wages and self-employment income. (j) Subpart J relates to procedures for determining and reviewing entitlement to and payment of benefits and lump sums, determining and reviewing rights with respect to the establishment and continuance of a period of disability, the revision of earnings records, and the representation of parties. (k) Subpart K relates to employment, wages, self-employment and selfemployment income. (1) Subpart L relates to determinations of relationship of a claimant to the individual on whose earnings the application is based. (m) Subpart M relates to coverage of employees of State and local Governments. (n) Subpart N relates to benefits in cases involving veterans. (0) Subpart O relates to the interrelationship of the old-age, survivors and disability insurance program with the railroad retirement program. (p) Subpart P relates to rights and benefits based on disability. (q) Subpart Q of this part relates to the selection of a representative payee to receive benefits on behalf of a beneficiary and to the duties and responsibilities of a representative payee. [26 F.R. 7054, Aug. 5, 1961; 26 F.R. 7760, Aug. 19, 1961, as amended at 27 F.R. 4513, May 11, 1962; 28 F.R. 14492, Dec. 31, 1963] § 404.2 General definitions and use of terms. (a) Terms relating to acts and regulations. (1) "The act" means the Social Security Act, as amended, as in effect July 1, 1961. (2) "Social Security Act" means the act approved August 14, 1935 (49 Stat. 620). (3) "Social Security Act Amendments of 1950" means the act approved August 28, 1950 (64 Stat. 477). (4) "Social Security Act Amendments of 1952" means the act approved July 18, 1952 (66 Stat. 767). (5) "Social Security Amendments of 1954" means the act approved September 1, 1954 (68 Stat. 1052). (6) "Social Security Amendments of 1956" means the act approved August 1, 1956 (70 Stat. 807). (7) "Social Security Amendments of 1958" means the act approved August 28, 1958 (72 Stat. 1013). (8) "Social Security Amendments of 1960" means the act approved September 13, 1960 (74 Stat. 924). (9) "Social Security Amendments of 1961" means the act approved June 30, 1961 (75 Stat. 131). (10) "Regulations 2" (20 CFR, 1938 ed. Part 402) means the regulations approved July 20, 1937, as amended from time to time, relating to Federal old-age benefits under title II of the Social Security Act and amendments to such title effective prior to January 1, 1940. (11) "Regulations 3" (20 CFR, 1961 ed., Part 403) means the regulations approved May 21, 1940, as amended and supplemented from time to time, relating to Federal old-age and survivors benefits under title II of the Social Security Act and amendments to such title effective prior to January 1, 1951. (12) "Internal Revenue Code of 1939" means the act approved February 10, 1939 (53 Stat. Part 1), as amended. (13) "Internal Revenue Code of 1954" means the act approved August 16, 1954 (68A Stat. 1), as amended. (14) "Railroad Retirement Act" means the Railroad Retirement Act of 1937 (50 Stat. 307), as amended. (15) "Section" means a section of the regulations in Part 404 of this chapter unless the context indicates otherwise. (b) Secretary; Commissioner; Administration; Appeals Council; Hearing Examiner defined. (1) "Secretary" means the Secretary of Health, Education, and Welfare. (2) "Commissioner" means the Commissioner of Social Security. (3) "Administration," except where the context clearly indicates otherwise, means the Social Security Administration in the Department of Health, Education, and Welfare. (4) "Appeals Council" means the Appeals Council of the Bureau of Hearings and Appeals in the Social Security Administration or such member or members thereof as may be designated by the Chairman. (5) "Hearing Examiner" (formerly designated "referee"), means a hearing examiner in the Bureau of Hearings and Appeals of the Social Security Administration. (c) Miscellaneous. (1) "Certify," when used in connection with the duty imposed on the Secretary by section 205 (i) of the act, means that action taken by the Administration in the form of a written statement addressed to the Managing Trustee, setting forth the name and address of the person to whom payment of a benefit or lump sum, or any part thereof, is to be made, the amount to be paid, and the time at which payment should be made. (2) "Benefit" means an old-age insurance benefit, disability insurance benefit, wife's insurance benefit, husband's insurance benefit, child's insurance benefit, widow's insurance benefit, widower's insurance benefit, mother's insurance benefit, or parent's insurance benefit under title II of the act. (Lump sums, which are death payments under title II of the act, are excluded from the term "benefit" as defined in this part to permit greater clarity in the regulations.) (3) "Lump sum" means a lump-sum death payment under title II of the act or any person's share of such a payment. (4) "Attainment of age." An individual attains a given age on the first moment of the day preceding the anniversary of his birth corresponding to such age. (5) "State," unless otherwise indicated, includes (i) the District of Columbia, (ii) the Virgin Islands, (iii) the Commonwealth of Puerto Rico effective January 1, 1951, (iv) Guam and American Samoa, effective September 13, 1960, generally, and for purposes of sections 210(a) and 211 of the act effective after 1960 with respect to service performed after 1960, and effective for taxable years beginning after 1960 with respect to crediting net earnings from self-employment and self-employment income, and (v) the Territories of Alaska and Hawaii prior to January 3, 1959, and August 21, 1959, respectively when those territories acquired statehood. (6) "United States," when used in a geographical sense, includes, unless otherwise indicated, (i) the States, (ii) the Territories of Alaska and Hawaii prior to January 3, 1959, and August 21, 1959, respectively, when they acquired statehood, (iii) the District of Columbia, (iv) the Virgin Islands, (v) the Commonwealth of Puerto Rico effective January 1, 1951, and (vi) Guam and American Samoa, effective September 13, 1960, generally, and for purposes of sections 210(a) and 211 of the act, effective after 1960 with respect to service performed after 1960, and effective for taxable years beginning after 1960 with respect to crediting net earnings from self-employment and self-employment income. (7) Masculine gender includes the feminine, unless otherwise indicated. (a) Extent to which Regulations No. 3 (20 CFR, 1961 ed., Part 403) remain in effect. Regulations No. 3 of the Social Security Administration (20 CFR, 1961 ed., Part 403) continue in effect with respect to old-age and survivors insurance benefits under title II of the Act for months prior to September 1950 (except with respect to additional deductions from such benefits under section 203(g) of the Act in effect prior to the Social Security Act Amendments of 1950); with respect to lump-sum death payments under title II of the Act where death occurred after 1939 and before September 1950; and with respect to determinations as to whether, under title II of the Act, services performed before 1951 constitute employment and remuneration paid before 1951 constitutes wages. Except as provided in this paragraph or as specifically incorporated into this Part 404 by reference, Regulations No. 3 of the Social Security Administration (20 CFR, 1961 ed., Part 403) are superseded by the regulations in this Part 404. (b) Effect of cross references. The cross references in the regulations in this Part 404 to other portions of the regulations, when the word "see" is used, are made only for convenience and shall be given no legal effect. (c) Periods of limitation ending on nonwork days. Pursuant to the provisions of section 216(j) of the act, effective September 13, 1960, where any provision of title II, or any provision of another law of the United States (other than the Internal Revenue Code of 1954) relating to or changing the effect of title II, or any regulation of the Secretary issued under title II, provides for a period within which an act is required to be done which affects eligibility for or the amount of any benefit or payment under this title or is necessary to establish or protect any rights under this title, and such period ends on a Saturday, Sunday, or Federal legal holiday or on any other day all or part of which is declared to be a nonwork day for Federal employees by statute or Executive Order, then such act shall be considered as done within such period if it is done on the first day thereafter which is not a Saturday, Sunday, or legal holiday or any other day all or part of which is declared to be a nonwork day for Federal employees either by statute or Executive Order. For purposes of this paragraph, the day on which a period ends shall include the final day of any extended period where such extension is authorized by law or by the Secretary pursuant to law. Such extension of any period of limitation does not apply to periods during which benefits may be paid for months prior to the month an application for such benefits is filed pursuant to § 404.607, or to periods during which an application for benefits may be accepted as such pursuant to § 404.606. (Sec. 216, 74 Stat. 994; 42 U.S.C. 416) [26 F.R. 7055, Aug. 5, 1961, as amended at 29 F.R. 15509, Nov. 19, 1964] Subpart B-Quarters of Coverage and Insured Status AUTHORITY: The provisions of this Subpart B issued under secs. 205, 216, 217, 223 and 1102, 53 Stat. 1368, as amended, 68 Stat. 1081, as amended, 70 Stat. 815, as amended, 49 Stat. 647, as amended; sec. 5 of Reorganization Plan No. 1 of 1953, 67 Stat. 18, 631; 42 U.S.C. 405, 416, 417, 423 and 1302. Sections 404.102 to 404.106 also issued under sec. 213, 64 Stat. 504, as amended; 42 U.S.C. 413; §§ 404.108 to 404.114 also issued under sec. 214, 64 Stat. 505, as amended; 42 U.S.C. 414. § 404.120(a) also issued under sec. 5(k) of the Railroad Retirement Act of 1937, as amended, 68 Stat. 1081, as amended; 45 U.S.C. 228e. Additional authority is cited in parentheses following the sections affected. SOURCE: The provisions of this Subpart B appear at 28 F.R. 3378, Apr. 6, 1963; 28 F.R. 3695, Apr. 16, 1963 unless otherwise noted. § 404.101 Insured status; general. The insured status of an individual is a basic factor in determining entitlement on his earnings record to monthly benefits, special age 72 payments, the lumpsum death payment, and the establishment of a period of disability. For example, an individual must be "fully insured" (see §§ 404.108-404.113) to qualify for old-age insurance benefits, and either "fully" or "currently" insured (see § 404.114) for mother's insurance benefits or the lump-sum death payment to be payable on his earnings account. An individual is "fully" or "currently" insured when he has acquired sufficient "quarters of coverage" (see § 404.103) to give him such status. If an individual is neither "fully" nor "currently" insured, no monthly insurance benefit or lumpsum death payment is payable on the basis of his earnings record. Subpart D of this part explains which benefits are based on a fully insured status, which are based on a currently insured status, and which are based on both a "fully” and "currently" insured status. (Sec. 228, 80 Stat. 67; 42 U.S.C. 428) [34 F.R. 18933, Nov. 27, 1969] § 404.102 Quarter and calendar ter defined. quar. The terms "quarter" and "calendar quarter" are used interchangeably to mean a period of 3 calendar months ending March 31, June 30, September 30, or December 31 of any year. § 404.103 Quarters of coverage. (a) General. A calendar quarter may be credited as a quarter of coverage if at least a specified minimum amount of wages are paid (or earned, under certain conditions-see paragraph (e) of this section) in such quarter, or if at least a specified amount of self-employment income is credited to such quarter, or if such quarter occurs in a year in which an individual has a specified amount of wages or self-employment income or a combination of both. However, certain calendar quarters may not be credited as quarters of coverage even though the wage or self-employment income requirements may be met in such quarters. Calendar quarters are credited as quarters of coverage in accordance with the rules in the following paragraphs of this section but subject to the limitations described in § 404.104. (See Subpart K for a definition of "wages" and "selfemployment income." See section 229 of the Act for wages deemed to have been paid a member of the uniformed services.) (b) Quarters of coverage based on wages paid in, or self-employment income credited to, a calendar quarter. Subject to the limitations in § 404.104, a quarter of coverage is a calendar quarter in which an individual: (1) Has been paid $50 or more wages (however, see paragraph (c) of this section where wages are paid for agricultural labor performed after 1954; and § 404.106 in case of wages paid in 1937); or |