Information Collection

Request for Reinstatement (Title XVI)

IC 45441 under ICR 200609-0960-029 · OMB 0960-0744.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0744 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-372 Request for Reinstatement (Title XVI)	Form
EXR Cover Closeout Notice Cover Letter.doc	Instruction
SSA-372 Request for Reinstatement -- Title XVI SSA-372.pdf	Form

IC Title:

Request for Reinstatement (Title XVI)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.999-416.999d

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-372	Request for Reinstatement -- Title XVI	SSA-372.pdf		No		Paper Only
Instruction			EXR Cover Closeout Notice Cover Letter.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.