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67436 Federal Register / Vol. 67, No.

214 / Tuesday, November 5, 2002 / Notices

coordinating the United States (U.S.) Dated: October 28, 2002. (Catalog of Federal Domestic Assistance,
and Australian social security programs Jo Anne B. Barnhart, Programs 96.001 Social Security—Disability
entered into force on October 1, 2002. Commissioner of Social Security. Insurance; 96.006 Supplemental Security
The agreement with Australia, which [FR Doc. 02–28027 Filed 11–4–02; 8:45 am]
was signed on September 27, 2001, is BILLING CODE 4191–02–P
Dated: October 25, 2002.
similar to U.S. social security Jo Anne B. Barnhart,
agreements already in force with 19 Commissioner of Social Security.
other countries—Austria, Belgium, SOCIAL SECURITY ADMINISTRATION
Policy Interpretation Ruling
Canada, Chile, Finland, France,
Social Security Ruling, SSR 02–2p; Titles II and XVI: Evaluation of
Germany, Greece, Ireland, Italy, Korea
Titles II and XVI: Evaluation of Interstitial Cystitis
(South), Luxembourg, the Netherlands, Interstitial Cystitis
Norway, Portugal, Spain, Sweden, Purpose: To provide guidance on SSA
Switzerland, and the United Kingdom. AGENCY: Social Security Administration. policy concerning the development and
Agreements of this type are authorized ACTION: Notice of Social Security Ruling. evaluation of interstitial cystitis (IC) in
by section 233 of the Social Security disability claims filed under titles II and
SUMMARY: In accordance with 20 CFR
Act. XVI of the Social Security Act (the Act).
402.35(b)(1), the Commissioner of Social Citations: Sections 216(i), 223(d),
The U.S.-Australian agreement Security gives notice of Social Security 223(f), 1614(a), and 1614(c) of the Act,
eliminates dual coverage and Ruling, SSR 02–2p. This Ruling clarifies as amended; Regulations No. 4, subpart
contributions under the U.S. Social the policies of the Social Security P, sections 404.1502, 404.1505,
Security program and the Australian Administration for developing and 404.1508, 404.1509, 404.1511, 404.1512,
program of mandatory employer evaluating title II and title XVI claims 404.1513, 404.1520, 404.1520a,
retirement contributions known as for disability on the basis of Interstitial 404.1521, 404.1523, 404.1525, 404.1526,
‘‘Superannuation Guarantee.’’ U.S. Cystitis (IC). IC is a complex, chronic 404.1528, 404.1529, 404.1530, 404.1545,
companies that employ U.S. citizens or bladder disorder characterized by 404.1546, 404.1561, 404.1594, and
residents in Australia have frequently urinary frequency, urinary urgency, and appendix 1; and Regulations No. 16,
been required to pay contributions with pelvic pain. subpart I, sections 416.902, 416.905,
respect to the employees’ wages under EFFECTIVE DATE: November 5, 2002. 416.906, 416.908, 416.909, 416.911,
both the U.S. Social Security program FOR FURTHER INFORMATION CONTACT: 416.912, 416.913, 416.920, 416.920a,
and Australia’s Superannuation Carolyn Kiefer, Office of Disability, 416.921, 416.923, 416.924, 416.925,
Guarantee program. Australian Social Security Administration, 6401 416.926, 416.926a, 416.928, 416.929,
companies with Australian employees Security Boulevard, Baltimore, MD 416.930, 416.945, 416.946, 416.961,
working in the United States have 21235–6401, (410) 965–9104. For 416.994, and 416.994a.
frequently faced the same dual information on eligibility or filing for Introduction: The Act and our
benefits, call our national toll-free implementing regulations require that
contribution obligation. Under the U.S.-
number 1–800–772–1213 or TTY 1– an individual establish disability based
Australian agreement, workers are
800–325–0778, or visit our Internet web on the existence of a medically
covered under one program or the other, site, Social Security Online, at http://
but not both, and contributions are only determinable impairment; that is, one that can be shown by medical evidence,
due under that one program. A worker
who is sent by an employer in one SUPPLEMENTARY INFORMATION: Although consisting of symptoms, signs, and
we are not required to do so pursuant laboratory findings. Disability may not
country to work in the other country for
to 5 U.S.C. 552(a)(1) and (a)(2), we are be established on the basis of an
5 years or less remains covered only by
publishing this Social Security Ruling individual’s statement of symptoms
the program of the sending country. The
in accordance with 20 CFR 402.35(b)(1). alone.
agreement includes additional rules that Social Security Rulings make This Ruling explains that IC (a
eliminate dual U.S. and Australian available to the public precedential complex, chronic bladder disorder),
coverage in other work situations. decisions relating to the Federal old-age, when accompanied by appropriate
The agreement also helps eliminate survivors, disability, supplemental symptoms, signs, and laboratory
situations where workers suffer a loss of security income, and black lung benefits findings, is a medically determinable
benefit rights under the social security programs. Social Security Rulings may impairment that can be the basis for a
system of one or both countries because be based on case decisions made at all finding of ‘‘disability.’’ It also provides
they have divided their careers between administrative levels of adjudication, guidance for the evaluation of claims
the two countries. Under the agreement, Federal court decisions, Commissioner’s involving IC.
workers may qualify for partial social decisions, opinions of the Office of
Policy Interpretation
security benefits from each country General Counsel, and policy
based on combined credits from both interpretations of the law and General
countries. regulations.
Although Social Security Rulings do 1. What Is IC?
Individuals who wish to obtain copies not have the same force and effect as the IC is a complex, chronic bladder
of the agreement or want more statute or regulations, they are binding disorder characterized by urinary
information about its provisions may on all components of the Social Security frequency, urinary urgency, and pelvic
write to the Social Security Administration, in accordance with 20 pain. IC occurs most frequently in
Administration, Office of International CFR 402.35(b)(1), and are relied upon as women (about 10 times more often than
Programs, Post Office Box 17741, precedents in adjudicating cases. in men), and sometimes prior to age 18.
Baltimore, MD 21235–7741 or visit the If this Social Security Ruling is later IC may be associated with other
Social Security Web site at superseded, modified, or rescinded, we disorders, such as fibromyalgia, chronic will publish a notice in the Federal fatigue syndrome, allergies, irritable
Register to that effect. bowel syndrome, inflammatory bowel

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Federal Register / Vol. 67, No. 214 / Tuesday, November 5, 2002 / Notices 67437

disease, endometriosis, and vulvodynia bladder wall after hydrodistention on result in death or which has lasted or
(vulvar/vaginal pain). IC also may be cystoscopy; can be expected to last for a continuous
associated with systemic lupus • Hunner’s ulcers on the bladder wall period of not less than 12 months.2
erythematosus. after hydrodistention on cystoscopy; Sections 223(d)(3) and 1614(a)(3)(D)
The symptoms of IC may vary in and, of the Act and 20 CFR 404.1508 and
incidence, duration, and severity. The • Absence of other disorders that 416.908 require that an impairment
causes of IC are currently unknown, and could cause the symptoms. result from anatomical, physiological, or
treatments are directed towards relief of Diagnostic tests used to identify or psychological abnormalities that can be
symptoms. While no treatment is exclude other disorders include shown by medically acceptable clinical
uniformly effective for everyone, there urinalysis, urine culture, urine cytology, and laboratory diagnostic techniques.
are many treatments available, and cystoscopy, biopsy of the bladder wall, The Act and regulations further require
individuals may obtain some measure of and, in men, culture of prostate that an impairment be established by
relief. However, response to treatment is secretions. medical evidence that consists of
The standard test currently used to symptoms, signs, and laboratory
variable, and some individuals may
aid in the diagnosis of IC is a cystoscopy findings, and not only by an
have symptoms that are intractable to
with hydrodistention of the bladder individual’s statement of symptoms.
the current treatments available.
(performed under anesthesia). It can be
Treatment may include bladder 4. How Is IC Identified as a Medically
used to reveal glomerulations or
distention; bladder instillation; oral Determinable Impairment?
Hunner’s ulcers. A biopsy of the bladder
drugs, such as the prescription drug
wall can be taken to rule out diseases We 3 generally will rely on the
Elmiron, antidepressants,
such as bladder cancer. Cystoscopy with judgment of a physician who has made
antihistamines, and narcotic analgesics;
hydrodistention also makes it possible the diagnosis after a review of the
and the use of transcutaneous electrical
to estimate bladder capacity, which is claimant’s medical history, a physical
nerve stimulation.
an important guide to treatment. The examination of the claimant, and any
2. How Is IC Diagnosed? hydrodistention of the bladder itself pertinent testing to establish the
also sometimes provides a therapeutic existence of IC. In the absence of
The diagnosis is one of exclusion. A
benefit, with a reduction in pain and evidence to the contrary in the case
physician must rule out other
urinary frequency for a limited time record, we will find a medically
conditions before making a diagnosis of
period. A report on the results of a determinable impairment is established
IC because there is currently no
cystoscopy, if done, should be part of if the evidence contains the appropriate
definitive test to identify IC. The
the medical record. An absence of symptoms, signs, and laboratory
symptoms of IC are similar to those of
glomerulations or Hunner’s ulcers on findings, as discussed under question 2
other disorders, such as acute urinary
cystoscopy does not exclude a diagnosis above. However, if there is evidence that
tract or vaginal infections, post-
of IC; a minority of individuals with IC indicates that the diagnosis is
radiation bladder inflammation or
(10%) will not have either of these questionable, and the evidence is
infection, bladder cancer, kidney stones,
medical signs. Cystoscopy should not be inadequate to determine whether or not
endometriosis, neurological disorders,
purchased to establish a diagnosis of IC the individual is disabled, we will
sexually transmitted diseases, and, in
because it is an invasive procedure. contact the treating source for
men, chronic bacterial and nonbacterial
While the medical findings discussed clarification, using the guidelines in 20
above are the principal symptoms, CFR 404.1512(e) and 416.912(e).
Symptoms of IC vary both in kind and signs, and laboratory findings currently
in intensity from individual to used to establish a diagnosis of IC, and, 5. How Do We Consider IC in the
individual, and even in the same consequently, the existence of a Sequential Evaluation Process? 4
individual. The three most common medically determinable impairment, Once we determine that the
symptoms are an urgent need to urinate they are not all-inclusive. As progress is individual has the medically
(urgency), a frequent need to urinate made in medical research into IC,
(frequency), and pain in the bladder and additional signs and laboratory findings 2 For a child under age 18 claiming benefits under
surrounding pelvic region. These may be identified and new diagnostic title XVI, disability will be established if the child
symptoms may occur either singly or in techniques may be developed that also
is suffering from a medically determinable physical
combination. The pain may range from or mental impairment (or combination of
would establish a diagnosis of IC. The impairments) that results in ‘‘marked and severe
mild discomfort to extreme distress. The existence of IC may be documented with functional limitations.’’ See section 1614(a)(3)(C) of
intensity of the pain may increase as the medical signs or laboratory findings the Act and 20 CFR 416.906. However, for clarity,
bladder fills, and decrease as it empties. other than those listed above, provided
the following discussions refer only to claims of
In addition, many patients experience individuals claiming disability benefits under title
that such documentation is consistent II and individuals age 18 or older claiming
vaginal, testicular or penile pain, or low with medically accepted clinical disability benefits under title XVI. The concepts in
back and thigh pain. A woman’s practice and is consistent with the other this ruling, however, are also intended to apply in
symptoms may worsen around the time evidence in the case record.
determining disability based on IC for individuals
of menstruation. under age 18 under title XVI.
3 The terms we and us in this Social Security
A diagnosis of IC is based on the 3. What Is a Medically Determinable
Ruling have the same meaning as in 20 CFR
presence of some or all of the following: Impairment? 404.1502 and 416.902. We or us refers to either the
• Presence of urinary urgency or Sections 216(i) and 1614(a)(3) of the Social Security Administration or the State agency
frequency (day and/or night), either making the disability or blindness determination;
Act define ‘‘disability’’ 1 as the inability i.e., our adjudicators at all levels of the
singly or in combination; to engage in any substantial gainful administrative review process and our quality
• Pain in the bladder and activity by reason of any medically reviewers.
surrounding pelvic region; determinable physical or mental 4 For ease of reading, we refer in this Ruling only

• Suprapubic tenderness on physical impairment (or combination of to the steps of the sequential evaluation processes
for initial adult claims, 20 CFR 404.1520 and
examination; impairments) which can be expected to 416.920. We use separate sequential evaluation
• Glomerulations (pinpoint bleeding processes when we do continuing disability
caused by recurrent irritation) on the 1 Except for statutory blindness. Continued

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67438 Federal Register / Vol. 67, No. 214 / Tuesday, November 5, 2002 / Notices

determinable impairment IC, we will impairment when, alone or in functional effects of IC combined with
consider it in determining whether: combination with another medically other impairments. IC in combination
• The individual’s impairment(s) is determinable physical or mental with another impairment may or may
severe. impairment(s), it significantly limits an not increase the severity or functional
• The individual’s impairment(s) individual’s physical or mental ability limitations of the other impairment. We
meets or equals the requirements of a to do basic work activities. (For children will evaluate each case based on the
listed impairment in the listings. applying for disability under title XVI, information in the case record.
• The individual’s impairment(s) we will find that IC is a ‘‘severe’’ Further, we will never deny an
prevents him or her from doing past impairment when it causes more than individual’s claim because the
relevant work and other work that exists minimal functional limitations.) We also individual’s IC does not meet or
in significant numbers in the national will consider the effects of any medically equal a listing. If an
economy. symptoms (such as pain or fatigue) that individual with IC has a severe
6. Can We Find an Individual Disabled could limit functioning. (See SSR 85– impairment that does not meet or
Based on IC Alone? 28, ‘‘Titles II and XVI: Medical medically equal a listing, we may still
Impairments That Are Not Severe’’ and find the individual disabled based on
If an individual has the medically
SSR 96–3p, ‘‘Titles II and XVI: other rules in the ‘‘sequential evaluation
determinable impairment IC that is
Considering Allegations of Pain and process’’ that we use to evaluate all
‘‘severe’’ as described in question 7
Other Symptoms In Determining disability claims.
below, we may find that the IC
Whether a Medically Determinable
medically equals a listing, if Sequential Evaluation: Steps 4 and 5,
Impairment Is Severe.’’) Therefore, we
appropriate. (See 20 CFR 404.1525 and Assessing Functioning in Adults; Step 3,
will find that an impairment(s) is ‘‘not
416.925.) (In the case of a child seeking Assessing Functional Equivalence in
severe’’ only if it is a slight abnormality
benefits under title XVI, we also may Children
(or a combination of slight
find that it functionally equals the
abnormalities) that has no more than a 9. How Do We Evaluate IC in Assessing
listings (20 CFR 416.926a).) We also
minimal effect on the individual’s Residual Functional Capacity (RFC) in
may find in a title II claim, or an adult
ability to do basic work activities (or, for Adults and Functional Equivalence in
claim under title XVI, that the IC results
a child applying under title XVI, if it Children?
in a finding that the individual is
causes no more than minimal functional
disabled based on his or her residual IC can cause limitation of function.
functional capacity (RFC), age, The functions likely to be limited
education, and past work experience. Sequential Evaluation: Step 3, the depend on many factors, including
An individual with IC also may report Listings urinary frequency and pain. An
symptoms suggestive of a mental individual may have limitations in any
impairment (for example, the individual 8. How Do We Evaluate IC at Step 3 of
Sequential Evaluation, the Listings? of the exertional functions such as
may say that he or she is anxious or sitting, standing, walking, lifting,
depressed, having difficulties with IC may be a factor in both ‘‘meets’’ carrying, pushing, and pulling. It also
memory and concentration, etc.). If the and ‘‘equals’’ determinations. may affect ability to do postural
evidence supports a possible discrete Because there is no listing for IC, we
functions, such as climbing, balancing,
mental impairment or symptoms such will find that an individual with IC
stooping, and crouching. The ability to
as anxiety or depression resulting from ‘‘meets’’ the requirements of a listing if
tolerate extreme heat, humidity, or
the individual’s IC or the side effects of he or she has another impairment that,
hazards also may be affected.
medication, we will develop the by itself, meets the requirements of a
possible mental impairment. If the listing. We also will find that a listing The effects of IC may not be obvious.
evidence does not establish a medically is met if there is an impairment that, in For example, many people with IC have
determinable mental impairment, but combination with IC, meets the chronic pelvic pain, which can affect
does establish the presence of symptoms requirements of a listing. For example, the ability to focus and sustain attention
such as anxiety or depression resulting IC may increase the severity of on the task at hand. Nocturia (nighttime
from the individual’s IC or side effects coexisting or related impairments, urinary frequency) may disrupt sleeping
of medication, we will determine including mental disorders, to the patterns. This can lead to drowsiness
whether there are any work-related extent that the combination of and lack of mental clarity during the
functional limitations resulting from the impairments meets the requirements of day. IC also may affect an individual’s
symptoms. We will address any work- a listing. This also may be true in the social functioning. The presence of
related functional limitations at steps 4 reverse; coexisting or related urinary frequency alone can necessitate
and 5 of the sequential evaluation impairments may increase the severity trips to the bathroom as often as every
process. of IC. 10 to 15 minutes, day and night.
We also may find that IC, by itself, is Consequently, some individuals with IC
Sequential Evaluation: Step 2, Severe medically equivalent to a listed essentially may confine themselves to
Impairment impairment (or, in the case of a child their homes. In assessing RFC, we must
7. When Is IC a ‘‘Severe’’ Impairment? applying under title XVI, also consider all of the individual’s
functionally equivalent to the listings). symptoms in deciding how such
As with any other medical condition, symptoms may affect functional
we will find that IC is a ‘‘severe’’ We also will find equivalence if an
individual has multiple impairments, capacities.
reviews; i.e., reviews to determine whether
including IC, no one of which meets or An assessment also should be made of
individuals who are receiving disability benefits are equals the requirements of a listing, but the effect IC has upon the individual’s
still disabled, or when we determine whether an the combination of impairments is ability to perform routine movement
individual has a ‘‘closed period of disability.’’ equivalent in severity to a listed and necessary physical activity within
These rules are set out in 20 CFR 404.1594 and
416.994, and the guidance in this Ruling applies to
impairment. the work environment. Individuals with
all of the appropriate steps in those regulations as However, we will not make IC may have problems with the ability
well. assumptions about the severity or to sustain a function over time.

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Federal Register / Vol. 67, No. 214 / Tuesday, November 5, 2002 / Notices 67439

As explained in SSR 96–8p (‘‘Titles II Council Levels of Administrative Correction to Previous Notice
and XVI: Assessing Residual Functional Review; Medical Equivalence’’; SSR 96– In the Federal Register of October 23,
Capacity in Initial Claims’’), our RFC 7p, ‘‘Titles II and XVI: Evaluation of 2002, Volume 67, Page 65169, the Office
assessments must consider an Symptoms in Disability Claims: of the United States Trade
individual’s maximum remaining Assessing the Credibility of an Representative published a notice
ability to do sustained work activities in Individual’s Statements’’; SSR 96–8p, entitled ‘‘Determinations Under the
an ordinary work setting on a regular ‘‘Titles II and XVI: Assessing Residual African Growth and Opportunity Act.’’
and continuing basis. A ‘‘regular and Functional Capacity in Initial Claims’’; A correction is being made to the
continuing basis’’ means 8 hours a day, and SSR 96–9p, ‘‘Titles II and XVI: information that appeared under
for 5 days a week, or an equivalent work Determining Capability to Do Other SUPPLEMENTARY INFORMATION. The
schedule.5 In cases involving IC, fatigue Work—Implications of a Residual reference to Presidential Proclamation
may affect the individual’s physical and Functional Capacity for Less Than a 7360 of October 2, 2000 was incorrect.
mental ability to sustain work activity. Full Range of Sedentary Work.’’ The correct citation is Presidential
This may be particularly true in cases [FR Doc. 02–28057 Filed 11–4–02; 8:45 am] Proclamation 7350 of October 2, 2000.
involving urinary frequency.
For a child applying for benefits Rosa M. Whitaker,
under title XVI, we will evaluate the Assistant United States Trade Representative
functional consequences of IC (either for Africa, Office of the United States Trade
alone or in combination with other DEPARTMENT OF STATE Representative.
impairments) to decide if the child’s [Public Notice 4159] [FR Doc. 02–28063 Filed 11–4–02; 8:45 am]
impairment(s) functionally equals the BILLING CODE 3190–01–M
listings. For example, the functional Renewal of the Overseas Schools
limitations imposed by IC, by itself or in Advisory Council
combination with another DEPARTMENT OF TRANSPORTATION
The Department of State is renewing
impairment(s), may establish an extreme
the Overseas Schools Advisory Council
limitation in one broad area of Office of the Secretary
to provide a formal channel for regular
functioning (e.g., attending and
consultation and advice from U.S. Aviation Proceedings, Agreements
completing tasks) or marked limitations
corporations and foundations regarding Filed During the Week Ending October
in two broad areas of functioning (e.g.,
American-sponsored overseas schools. 25, 2002
attending and completing tasks, and
The Under Secretary for Management
interacting and relating with others). The following Agreements were filed
As with any other impairment, we has determined that the committee is
necessary and in the public interest. with the Department of Transportation
will explain how we reached our under the provisions of 49 U.S.C.
conclusions on whether IC caused any Members of the committee will be
appointed by the Assistant Secretary for Sections 412 and 414. Answers may be
physical or mental limitations. filed within 21 days after the filing of
Administration. The committee will
EFFECTIVE DATE: This Ruling is effective the application.
follow the procedures prescribed by the
November 5, 2002. Docket Number: OST–2002–13631.
Cross-References: SSR 85–28, ‘‘Titles Federal Advisory Committee Act
(FACA). Meetings will be open to the Date Filed: October 22, 2002.
II and XVI: Medical Impairments That Parties: Members of the International
Are Not Severe’’; SSR 96–2p, ‘‘Titles II public unless a determination is made
in accordance with the FACA section Air Transport Association.
and XVI: Giving Controlling Weight to Subject:
Treating Source Medical Opinions’’; 10(d) and 5 U.S.C. 552b(c) (1) and (4)
that a meeting or a portion of the PTC23 AFR–TC3 0184 dated 22
SSR 96–3p, ‘‘Titles II and XVI: October 2002.
Considering Allegations of Pain and meeting should be closed to the public.
Notice of each meeting will be provided Mail Vote 247—TC23/TC123 Africa-
Other Symptoms in Determining South East Asia.
Whether a Medically Determinable in the Federal Register at least 15 days
prior to the meeting date. Special Passenger Amending
Impairment is Severe’’; SSR 96–4p, Resolution 010e r1–r2.
For further information, contact Dr.
‘‘Titles II and XVI: Symptoms, PTC23 AFR–TC3 0185 dated 22
Keith D. Miller, Executive Secretary of
Medically Determinable Physical and October 2002.
the committee at 202–261–8200.
Mental Impairments, and Exertional and Mail Vote 248—TC23/TC123 Africa-
Nonexertional Limitations’’; SSR 96–5p, Dated: October 30, 2002.
‘‘Titles II and XVI: Medical Source Keith D. Miller, Special Passenger Amending
Opinions on Issues Reserved to the Executive Secretary, Overseas Schools Resolution 010f r3–r13.
Commissioner’’; SSR 96–6p, ‘‘Titles II Advisory Council, Department of State. Intended effective date: 15 November
and XVI: Consideration of [FR Doc. 02–28088 Filed 11–4–02; 8:45 am] 2002.
Administrative Findings of Fact by State BILLING CODE 4710–24–P Docket Number: OST–2002–13681.
Agency Medical and Psychological Date Filed: October 23, 2002.
Consultants and Other Program Parties: Members of the International
Physicians and Psychologists at the OFFICE OF THE UNITED STATES Air Transport Association.
Administrative Law Judge and Appeals TRADE REPRESENTATIVE Subject:
Mail Vote 239.
5 However, see footnote 2 of SSR 96–8p. That
Determinations Under the African PTC123 0201 dated 16 September
footnote explains that the ability to work 8 hours Growth and Opportunity Act:
a day for 5 days a week is not always required for 2002 r1–r18.
a finding at step 4 of the sequential evaluation Correction PTC123 0210 dated 11 October 2002
process for adults when an individual can do past (Affirmative).
relevant work that was part-time work, if that work AGENCY: Office of the United States
was substantial gainful activity, performed within Trade Representative. Minutes—PTC123 0217 dated 22
the applicable period, and lasted long enough for October 2002.
ACTION: Correction.
the person to learn to do it. Tables—PTC123 Fares 0072 dated 11

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