Request for Reinstatement (Title II)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0742 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-371 Request for Reinstatement (Title II) Form
SSA-371 Request for Reinstatement - Title II SSA-371 (Revised).pdf Form
SSA-371 (Current).pdf Form SSA-371 current version IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Reinstatement (Title II)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1592b - 404.1592f

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-371	Request for Reinstatement - Title II	SSA-371 (Revised).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Form SSA-371 current version	SSA-371 (Current).pdf	10/31/2012

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