Other Fields
Agency Scheme: 
SSAOBENE0001
Level: 
Appeal Level One
ADJUDICATION STRUCTURE
Appeals: Basic Structure
Appeal Office (local name): 
Office of Appellate Operations
Appeal Office (global name): 
Social Security Administration: Office of Appellate Operations
Sub-Agency/Bureau/Division:: 
Office of Adjudication and Review
Appeal Officer #1 (Title): 
Administrative Appeals Judge (AAJ)
Appeal Officer #2 (Title): 
Administrative Appeals Officer (AO)
Are administrative appeals permitted from final decisions issued by this appellate office?: 
No
Comments/Notes on Adjudication Structure: 
SSA administers (1) social insurance programs that provide monthly benefits to disabled workers, their spouses and children, and survivors of insured workers; (2) a need-based program for the aged, blind, and disabled; and (3) certain benefits under the Federal Coal Mine Health and Safety Act. Claimants appeal adverse initial determinations to the Office of the Chief Administrative Law Judge. Although ALJs hear the cases, the proceedings are informal and non-adversarial. Claimants may appeal adverse ALJ decisions to the Appeals Council. At the appellate level (the Appeals Council), AAJs retain authority to issue such final decisions.
PROCESS & PROCEDURE - General Information
Which party (or parties) is/are permitted to file appeals with this office?: 
Private Party
Are private parties permitted to have representation at appeal hearings?: 
Yes (All Types of Cases)
Who may serve as a private party representative?: 
Either
Is the agency permitted to have representation at appeal hearings?: 
N/A (e.g., Agency Not Party to Hearing)
Are ex parte contacts prohibited?: 
Yes (All Types of Cases)
Regulations/rules of practice for appeal hearings (please include CFR citations): 
20 CFR 404.929-404.961, 405.301-405.383, 408.1040-408.1045, 416.1429-416.1461
Other published guidance for appeal hearings (if any): 
Hearings, Appeals, and Litigation Law (HALLEX) Manual, Program Operations Manual System (POMS)
PROCESS & PROCEDURE - Hearing Procedure
What types of hearings are permitted on appeals adjudicated by this office?: 
Written (Document-Only) Hearing
In-Person
Video
Phone
Please provide the approximate percentage of each type of hearing relative to the total number of appeal hearings (FY2013)
Written (Document-Only) Hearing: 
100%
In-Person: 
0%
Video: 
0%
Phone: 
0%
How is the type of hearing selected for appeals heard by this office?: 
By Agency
By Private Party
Depends on Nature of Case/Claim
If "Depends on Nature of Case/Claim", please describe: 
A claimant may request an oral hearing. If the Appeals Council believes the case raises an important question of law or policy or that having an oral hearing will help reach a proper decision, it will grant such hearing. We note that the percentages above relate to request for review workloads for FY 2013 excluding our Retirement & Survivors Insurance workload as well as our representative sanction cases which typically include around one in person hearing a year.
How many appeal officers preside at each hearing?: 
Varies by Case
If "Varies by Case," please describe: 
Usually, cases are decided individually, by two-member panels, or by three-member panels. If the case is before a two-member panel and the members cannot agree on an outcome, the Chairman, Deputy Chairman, or his/her delegate will participate as a third member of a panel. At the discretion of the Chairman, the Appeals Council may meet en banc, or a representative body of the Appeals Council--which consists of not less than five members--shall meet to decide a case. See 20 CFR 422.205(c), 422.205(e)
Is factual development permitted at the appellate hearing as a means of supplementing the record from below?: 
Yes (Some Types of Cases)
Can third-parties submit amicus briefs and/or evidence?: 
No
Are appeal hearings recorded and/or transcribed?: 
Yes
N/A (Document-Only Hearings)
Are appeal hearings open to the public?: 
Varies by Case
If "Varies by Case," please describe: 
Appeal hearings are closed during oral hearings. This question is inapplicable to document-only hearings.
PROCESS & PROCEDURE - Post-Hearing Procedure
Who typically drafts final decisions on appellate cases adjudicated by this office?: 
Staff Attorney
Who has authority to issue final decisions on appellate cases adjudicated by this office?: 
Adjudication Officer
Do agency regulations or guidance provide time limits for issuance of final decisions on appellate cases?: 
No
About how long does it take on average—as of FY2013—to adjudicate appeals by this office?: 
364 Days
Is judicial review available after issuance of a final decision on appellate cases adjudicated by this office?: 
Yes (Some Types of Cases)
If "Yes (Some Types of Cases)," please describe types of decisions/cases that are judicially reviewable: 
When the Appeals Council dismisses a case, there is no judicial review, but all other cases have judicial review.
PROCESS & PROCEDURE - Case Management
How are claims/cases processed at this appellate office?: 
Differentiated Case Management
Please briefly describe your case management practice(s) at this office: 
The Appeals Council uses the case processing order that is the most efficient, and this can include first-in/first out. We make case processing decisions in an effort to optimize the number of claimants we are serving.
Does the agency permit web-based electronic filing of briefs or other documents in cases adjudicated by this appellate office?: 
Yes
Are final decisions issued by this appellate office published and/or posted on the agency website?: 
Yes (Some Decisions)
If "Yes (Some Decisions)," how does the agency determine which final decisions to publish/post? Please briefly describe: 
The Appeals Council only rarely publishes its decisions in the form of Appeals Council Interpretations.
Do agency regulations/rules of practice specify the contents of the administrative record on appeals heard by this office?: 
No
If "Yes," please provide citation(s): 
Subregulatory authority sets for the guidelines for contents of the record.
Do agency regulations/rules of practice provide for closure of the record on appeals heard by this office?: 
Yes (Some Types of Cases)
If "Yes," please provide citation(s): 
20 CFR 405.430 and 405.401(c) and 20 CFR 404.970(b) and 416.1470(b)
PROCESS & PROCEDURE
Comments/Notes on Appellate Process & Procedures (Optional): 
SSA has divided the country into ten regions. Region I operates under slightly different regulations than the other nine regions (see 20 CFR Part 405). The biggest difference--as it relates to the appellate level--between Region I and the other nine regions is that claimants are required to submit all evidence 5 days prior to the ALJ decision with some exceptions. Any new evidence offered at the Appeals Council, while the case is on appeal, must meet a higher standard than other regions for consideration. The 404 and 416 regulations cited above set forth how the Appeals Council addresses additional evidence in other cases. SSA notes that 364 days as the answer to the question re: how long it takes on average to adjudicate appeals is for request for review processing time. We have other workloads that are not factored into this number.
ADJUDICATORS
Total # of Appeal Officers: 
110
Comments/Notes on Appellate Adjudicators (Optional): 
The number of people in the Appeals Council--110--includes both Administrative Appeals Judges (with 2 rehired annuitants) and Administrative Appeals Officers as well as Senior Executives Service members who oversee the Appeals Council. Only Administrative Appeals Judges (AAJs) have the authority to grant review and issue decisions, dismissals, and remands as well as deny review on appellate cases. Appeals Officers with the Appeals Council only have the authority to deny a request for review. There are a few AOs who serve the Office of the Executive Director of the Office of Appellate Operations (which encompasses the Appeals Council), and do not work as full-time appeal officers.
ADR: General Information
Is ADR available at one or more points for appellate cases heard by this office?: 
No
CASELOAD STATISTICS - Summary Statistics
Total # Cases Filed/Opened (FY2013): 
172,492
Total # Cases Decided/Closed (FY2013): 
176,251
Total # Cases Pending (End of FY2013): 
157,311
CASELOAD STATISTICS - Supplementary Statistics
Does your agency maintain annual caseload statistics for this hearing office by case type (e.g., discrimination complaint, licen: 
Yes
Web address: 
http://www.ssa.gov/appeals/DataSets/07_AC_Requests_For_Review.html
WRAP-UP
Are there distinctive or innovative features of the appellate-level adjudication program covered on this form that you wish to: 
Claimants seeking disability benefits are entitled to a hearing before an Administrative Law Judge (ALJ), and the ALJ ultimately issues a decision granting or denying benefits. If claimants are unsatisfied with the decision, they can appeal to the Appeals Council that serves as the last appellate step in the agency. The Appeals Council began mapping out our business process and all possible case outcomes. Through this work, we identified approximately 2000 decisional points and used the information to build a case analysis tool that captured structured data about every ALJ decision we processed. Once we captured a full year of data, we started visualizing the data so that we would easily identify policy errors, and we have continued to collect and visualize the data for each subsequent year. For the most frequent policy errors, we re-examined the policies and sought outside assistance from the Administrative Conference of the United States to provide suggestions and recommendations to improve the policies. Simultaneously, the Appeals Council identified the need for quality mechanisms to review the ALJ decisions that were not appealed. We established the Division of Quality that reviews favorable ALJ decisions before payments are issued. With data collected through the case analysis tool and the Division of Quality, the Appeals Council was able to spot outlier behavior. Wanting to better understand outlier behavior, we created focused reviews for an in-depth look at specific issues. Focused reviews can center around a specific adjudicator, office, impairment type, representative, etc. Data gleaned from focused reviews proved to be valuable management information and a great source of feedback to individual adjudicators. The Appeals Council worked with others in the agency to develop additional methods of adjudicator feedback, such as the “How Am I Doing” tool that allows adjudicators to see data about their remands and compare their performance to others. The Appeals Council is also in the process of adding training modules to the reasons for remand so adjudicators access immediate training tailored to their needs. The Appeals Council also used data captured in their new employee training to revamp the training and move from a lecture training style to hands on approach using adult learning theories. This reduced the learning curve for new employees and won the Appeals Council the Edwards Deming Award, for the best training in the federal government. While the Appeals Council has made advances in numerous areas due to its innovative use of data, the best result remains improved service to the American public.
Setting aside budgetary or legislative constraints (if any), does your agency have a "wish list" of processes or procedures (e.g: 
Setting aside budgetary constraints, we would like to expand our Division of Quality by completing more own motion pre-effectuation reviews and post-effectuation focused reviews, add electronic filing of requests for review, and update case processing systems to allow for additional functionality.
Verified by Agency: 
Verified