Request for Reinstatement (Title II)

ICR 200909-0960-007

OMB: 0960-0742

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2009-12-08
Supplementary Document
2009-11-27
IC Document Collections
IC ID
Document
Title
Status
45431 Modified
ICR Details
0960-0742 200909-0960-007
Historical Active 200609-0960-028
SSA
Request for Reinstatement (Title II)
Revision of a currently approved collection   No
Regular
Approved without change 03/11/2010
Retrieve Notice of Action (NOA) 12/09/2009
  Inventory as of this Action Requested Previously Approved
03/31/2013 36 Months From Approved 05/31/2010
10,000 0 10,000
333 0 333
0 0 0

Through Form SSA–371, SSA obtains a signed statement from individuals stating a request for Expedited Reinstatement (EXR) of their Title II disability benefits, and proof the requestor meets the EXR requirements. SSA maintains the form in the disability folder of the applicant to demonstrate the individual’s awareness of the EXR requirements and their choice to request EXR. Respondents are individuals requesting expedited reinstatement of his or her Title II disability benefits.

US Code: 42 USC 423 Name of Law: Social Security Act
   PL: Pub.L. 106 - 170 112 Name of Law: Ticket to Work and Work Incentives Improvement Act of 1999
  
None

Not associated with rulemaking

  74 FR 51353 10/06/2009
74 FR 64801 12/08/2009
No

1
IC Title Form No. Form Name
Request for Reinstatement (Title II) SSA-371 Request for Reinstatement - Title II

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10,000 10,000 0 0 0 0
Annual Time Burden (Hours) 333 333 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$46,200
No
No
Uncollected
Uncollected
No
Uncollected
Elizabeth Davidson 411-965-0454 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/09/2009


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