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6418 Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulationsstricter standards. There will be net savings of approximately $12 million annually beginning with FY99. These savingswill result from fewer income and resource redeterminations, representative payee actions, and maintenance of therolls activities. The ongoing State workyear costs are for additional hearings, as well as medical reviews from additionalreconsiderations, resulting from the stricter childhood disability standard.Estimated administrative costs ($ in millions, rounded to the nearest $5 million) and workyears (rounded to thenearest 50) are:FY1997 FY1998 FY1999 FY2000 FY2001 FY2002 Total............................................................................. $185 $130 ¥$10 ¥$10 ¥$10 ¥$10 $265WorkyearsFederal .................................................................... 900 650 ¥250 ¥250 ¥250 ¥250 550State ........................................................................ 1,200 1,250 150 150 150 150 3,050Total ................................................................. 2,100 1,900 ¥100 ¥100 ¥100 ¥100 3,550Note: Annual numbers may not add to total due to rounding.Reductions in SSI Recipients (in thousands):We expect benefit eligibility for a total of 135,000 of those children receiving benefits at date of enactment willbe terminated as a result of these changes in the law. The following figures show the estimated annual effect ofthe legislation on projected numbers of recipients of Federal SSI benefits:FY1997 FY1998 FY1999 FY2000 FY2001 FY2002Current recipients .................................................................................................. ¥10 ¥95 ¥110 ¥95 ¥80 ¥70New awards .......................................................................................................... ¥10 ¥35 ¥50 ¥70 ¥80 ¥90Total ............................................................................................................... ¥20 ¥130 ¥160 ¥165 ¥160 ¥160With the reductions in SSI recipients shown above, we estimate the average number of disabled children (in thousands)in payment status after implementation of these interim final rules will be:FY1997 FY1998 FY1999 FY2000 FY2001 FY20021,010 950 955 990 1,015 1,040Note: Annual numbers may not add to total due to rounding.Regulatory Flexibility ActWe certify that these interim finalrules will not have a significanteconomic impact on a substantialnumber of small entities since this ruleaffects only individuals. Therefore, aregulatory flexibility analysis asprovided in Public Law 96–354, theRegulatory Flexibility Act, as amendedby Public Law 104–121 is not required.Paperwork Reduction ActThese interim final rules contain anew information collection requirementin Part 416, section 416.924(g). Asrequired by 44 U.S.C. 3507, as amendedby section 2 of the Paperwork ReductionAct of 1995, we have requested underemergency procedures, and OMB hasapproved, under OMB #0960–0568, theinformation collection requirementscontained in section 416.924(g).(Catalog of Federal Domestic Assistance:Program Nos. 96.001 Social Security-Disability Insurance; 96.006 SupplementalSecurity Income.)List of Subjects20 CFR Part 404Administrative practice andprocedure, Blind, Disability benefits,Old-Age, Survivors, and DisabilityInsurance, Reporting and recordkeepingrequirements, Social Security.20 CFR Part 416Administrative practice andprocedure, Aged, Blind, Disabilitybenefits, Public assistance programs,Reporting and recordkeepingrequirements, Supplemental SecurityIncome (SSI).Dated: February 5, 1997.Shirley S. Chater,Commissioner of Social Security.For the reasons set out in thepreamble, 20 CFR chapter III isamended as follows:PART 404—FEDERAL OLD-AGE,SURVIVORS AND DISABILITYINSURANCE (1950– )Subpart P—[Amended]1. The authority citation for subpart Pof part 404 is revised to read as follows:Authority: Secs. 202, 205(a), (b), and (d)–(h), 216(i), 221(a) and (i), 222(c), 223, 225,and 702(a)(5) of the Social Security Act (42U.S.C. 402, 405(a), (b), and (d)–(h), 416(i),421(a) and (i), 422(c), 423, 425, and902(a)(5)); sec. 211(b), Pub. L. 104–193, 110Stat. 2105, 2189.Appendix 1 to Subpart P—[Amended]2. Part B of Appendix 1 (Listing ofImpairments) of subpart P to part 404 isamended by revising the third sentenceof the second undesignated paragraph of103.00A, the fourth undesignatedparagraph of 103.00A, the fourthsentence of the fifth undesignatedparagraph of 104.00A, the sixthundesignated paragraph of 104.00A, thelast sentence of the last undesignatedparagraph of 104.00C, the first threesentences of the eighth undesignatedparagraph of 112.00A, the thirdsentence of the first paragraph of
Federal Register / Vol. 62, No. 28 / Tuesday, February 11, 1997 / Rules and Regulations6419112.00C, the first sentence of 112.00C2.introductory text 112.00C2.b.,112.00C2.c., the heading of 112.00C2.d.,112.00C4 and the undesignatedparagraph under it, and 112.02B2.c.introductory text to read as follows:Appendix 1 to Subpart P—Listing ofImpairments* * * * *Part B* * * * *103.00 Respiratory SystemA. * * ** * * * ** * * Even if a child does not showthat his or her impairment meets thecriteria of these listings, the child mayhave an impairment(s) that is medicallyor functionally equivalent in severity toone of the listed impairments. * * ** * * * *It must be remembered that theselistings are only examples of commonrespiratory disorders that are severeenough to find a child disabled. Whena child has a medically determinableimpairment that is not listed, animpairment that does not meet therequirements of a listing, or acombination of impairments no one ofwhich meets the requirements of alisting, we will make a determinationwhether the child’s impairment(s) ismedically or functionally equivalent inseverity to the criteria of a listing. (See§§ 404.1526, 416.926, and 416.926a.)* * * * *104.00 Cardiovascular SystemA. Introduction* * * * ** * * Even though a child who doesnot receive treatment may not be able toshow an impairment that meets thecriteria of these listings, the child mayhave an impairment(s) that is medicallyor functionally equivalent in severity toone of the listed impairments.Indeed, it must be remembered thatthese listings are only examples ofcommon cardiovascular disorders thatare severe enough to find a childdisabled. When a child has a medicallydeterminable impairment that is notlisted, an impairment that does not meetthe requirements of a listing, or acombination of impairments no one ofwhich meets the requirements of alisting, we will make a determinationwhether the child’s impairment(s) ismedically or functionally equivalent inseverity to the criteria of a listing. (See§§ 404.1526, 416.926, and 416.926a.)* * * * *C. Treatment and Relationship Status* * * * ** * * (See § 404.1594 or § 416.994a,as appropriate, for our rules on medicalimprovement and whether anindividual is no longer disabled.)112.00 Mental DisordersA. * * ** * * * *It must be remembered that theselistings are only examples of commonmental disorders that are severe enoughto find a child disabled. When a childhas a medically determinableimpairment that is not listed, animpairment that does not meet therequirements of a listing, or acombination of impairments no one ofwhich meets the requirements of alisting, we will make a determinationwhether the child’s impairment(s) ismedically or functionally equivalent inseverity to the criteria of a listing. (See§§ 404.1526, 416.926, and 416.926a.)* * ** * * * *C. * * * The functional areas that weconsider are: Motor function; cognitive/communicative function; socialfunction; personal function; andconcentration, persistence, or pace.* * *1. * * *2. Preschool children (age 3 toattainment of age 6). For the age groupsincluding preschool children throughadolescence, the functional areas usedto measure severity are: (a) Cognitive/communicative function, (b) socialfunction, (c) personal function, and (d)deficiencies of concentration,persistence, or pace resulting infrequent failure to complete tasks in atimely manner. * * *a. * * *b. Social function. Social functioningrefers to a child’s capacity to form andmaintain relationships with parents,other adults, and peers. Socialfunctioning includes the ability to getalong with others (e.g., family members,neighborhood friends, classmates,teachers). Impaired social functioningmay be caused by inappropriateexternalized actions (e.g., running away,physical aggression—but not selfinjuriousactions, which are evaluatedin the personal area of functioning), orinappropriate internalized actions (e.g.,social isolation, avoidance ofinterpersonal activities, mutism). Itsseverity must be documented in termsof intensity, frequency, and duration,and shown to be beyond what might bereasonably expected for age. Strength insocial functioning may be documentedby such things as the child’s ability torespond to and initiate social interactionwith others, to sustain relationships,and to participate in group activities.Cooperative behaviors, consideration forothers, awareness of others’ feelings,and social maturity, appropriate to achild’s age, also need to be considered.Social functioning in play and schoolmay involve interactions with adults,including responding appropriately topersons in authority (e.g., teachers,coaches) or cooperative behaviorsinvolving other children. Socialfunctioning is observed not only athome but also in preschool programs.c. Personal function. Personalfunctioning in preschool childrenpertains to self-care; i.e., personal needs,health, and safety (feeding, dressing,toileting, bathing; maintaining personalhygiene, proper nutrition, sleep, healthhabits; adhering to medication ortherapy regimens; following safetyprecautions). Development of self-careskills is measured in terms of the child’sincreasing ability to help himself/herselfand to cooperate with others in takingcare of these needs. Impaired ability inthis area is manifested by failure todevelop such skills, failure to use them,or self-injurious actions. This functionmay be documented by a standardizedtest of adaptive behavior or by a carefuldescription of the full range of self-careactivities. These activities are oftenobserved not only at home but also inpreschool programs.d. Concentration, persistence, or pace.* * ** * * * *4. Adolescents (age 12 to attainmentof age 18). Functional criteria parallel tothose for primary school children(cognitive/communicative; social;personal; and concentration,persistence, or pace) are the measure ofseverity for this age group. Testinginstruments appropriate to adolescentsshould be used where indicated.Comparable findings of disruption ofsocial function must consider thecapacity to form appropriate, stable, andlasting relationships. If information isavailable about cooperative workingrelationships in school or at part-time orfull-time work, or about the ability towork as a member of a group, it shouldbe considered when assessing thechild’s social functioning. Markedlyimpoverished social contact, isolation,withdrawal, and inappropriate orbizarre behavior under the stress ofsocializing with others also constitutecomparable findings. (Note that selfinjuriousactions are evaluated in thepersonal area of functioning.)a. Personal functioning in adolescentspertains to self-care. It is measured in
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