Information Collection

Request for Reinstatement (Title II)

IC 45431 under ICR 201507-0960-013 · OMB 0960-0742.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-371 Request for Reinstatement (Title II)	Form
SSA-371 Request for Reinstatement - Title II Form SSA-371 - Revised Version.pdf	Form
Form SSA-371 - Current Version.pdf Current SSA-371	IC Document

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:

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-371	Request for Reinstatement - Title II	Form SSA-371 - Revised Version.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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Current SSA-371	Form SSA-371 - Current Version.pdf	10/28/2015

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