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 FEDERAL REVIEWING OFFICIAL

The Federal Reviewing Official level replaces the Reconsideration level in the current process. Claims that are initially denied will inform claimants that they have the right to appeal within 60 days to the Federal Reviewing Official (RO). It will also explain the right to representation at the RO level. New evidence may be submitted at any time up to the time the decision is issued. If new evidence is submitted, or the RO disagrees with the initial decision, the RO must consult with the new Medical and Vocational Expert System (MVES). The RO will have final decision-making authority.

The Social Security Administration describes the new RO level as the linchpin of the new DSI process. The SSA anticipates that the required notice for the right to representation in the initial denial notice will lead to earlier representative involvement. The SSA hopes that the earlier representative involvement will result in more correct decisions earlier in the appeals process.

Reviewing an initial determination—general
If you are dissatisfied with the initial determination on your disability claim, you may request review by a Federal reviewing official.

How to request review of an initial determination
(a) Written request. You must request review by filing a written request. You should include in your request—
(1) Your name and social security number,
(2) If you have filed a claim for benefits based on disability under title II of the Act under an account other than your own, the name and social security number of the wage earner under whose account you are filing,
(3) The reasons you disagree with the initial determination on your disability claim,
(4) Additional evidence that you have available to you, and
(5) The name and address of your representative, if any.
(b) Time limit for filing request. We will review an initial determination if you request review in writing no later than 60 days after the date you receive notice of the initial determination (or within the extended time period if we extend the time as provided in paragraph (d) of this section).
(c) Place for filing request. You should submit a written request for review at one of our offices. If your disability claim is under title II of the Act, you may also file the request at the Veterans Administration Regional Office in the Philippines, or if you have 10 or more years of service, or at least five years of service accruing after December 31, 1995, in the railroad industry, an office of the Railroad Retirement Board.
(d) Extension of time to request review. If you want SSA to review the initial determination on your disability claim, but you do not request review timely, you may ask SSA for more time to request review. Your request for an extension of time must be in writing and must give the reasons the request for review was not filed, or cannot be filed, in time. If you show that you have good cause for missing the deadline, SSA will extend the time period. To determine whether good cause exists, SSA will use the standards explained in §405.20.

Procedures before a Federal reviewing official
(a) General. The Federal reviewing official will review existing evidence and accept and obtain new evidence in order to make a decision on your claim. The decision will be based on all evidence in the record.
(b) Developing the record. If you have additional evidence that you did not submit with your request for review, you should submit that evidence to the Federal reviewing official as soon as possible. If there is additional evidence that you wish to submit and you are having difficulty obtaining it, the Federal reviewing official may issue a subpoena for the evidence using the process and standards described in §405.217. If the Federal reviewing official determines that additional evidence is necessary, SSA may obtain such evidence from other sources, including the State agency.
(c) Seeking State agency clarification. In reviewing your claim, if the Federal reviewing official determines that additional information, beyond that provided by the claimant, is necessary, the Federal reviewing official may obtain it from other sources, including the State agency or a treating source. The State agency will provide such clarification or additional information to the Federal reviewing official on a timely basis. In such circumstances, the Federal reviewing official will retain the authority to make the decision as to whether or not you are disabled.

Subpoenas
(a) When it is reasonably necessary for the full presentation of a claim, SSA may issue subpoenas for the production of any documents that are relevant to an issue before the Federal reviewing official.
(b) To have documents subpoenaed, you must file a written request for a subpoena with SSA.
The written request must:
(1) Identify the documents with sufficient detail to find them;
(2) State the important facts that the document is expected to show; and
(3) Indicate why these facts could not be shown without that document.
(c) SSA will pay the cost of issuing the subpoena.
(d) Within five days of receipt of a subpoena, the person against whom the subpoena is directed may ask SSA to withdraw or limit the scope of the subpoena, setting forth the reasons why the subpoena should be withdrawn or why it should be limited in scope.
(e) Upon failure of any person to comply with a subpoena, the Office of the General Counsel may seek enforcement of the subpoena under section 205(e) of the Act.

Decision by the Federal reviewing official
(a) The Federal reviewing official will make a decision based on all of the evidence. The written decision will explain in clear and understandable language the specific reasons for the decision, including an explanation as to why the Federal reviewing official agrees or disagrees with the rationale in the initial determination.
(b) Before making his or her decision, the Federal reviewing official may consult with a medical, psychological, or vocational expert through the Medical and Vocational Expert System if the Federal reviewing official determines that such consultation is necessary. If the Federal reviewing official disagrees with the initial determination, or if you submit, or the Federal reviewing official otherwise obtains, new and material medical evidence, the Federal reviewing official will consult with a medical or psychological expert through the Medical and Vocational Expert System before making a decision. At all times, the Federal reviewing official retains the authority to make the decision as to whether you are disabled under SSA rules.

Notice of the Federal reviewing official's decision
SSA will mail a written notice of the Federal reviewing official's decision to you at your last known address. They will inform you of your right to a hearing before an administrative law judge.

The Federal reviewing official's decision is binding unless—
(a) You request a hearing before an administrative law judge under §405.310 within 60 days of the date you receive notice of the Federal reviewing official's decision and a decision is made by the administrative law judge,
(b) The expedited appeals process is used, or
(c) SSA revises the Federal reviewing official's decision.