Information Collection

SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government

IC 182804 under ICR 201701-0960-009 · OMB 0960-0105.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0105 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1372-BK-FC SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government	Form
SSA-1372-BK-FC Student's Statement Regarding School Attendance SSA-1372-bk-fc (revised).pdf	Form
ssa-1372-bk-fc.pdf Current Version SSA-1372-BK-FC	IC Document

IC Title:

SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government

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 404.367-404.368 20 CFR 404.350-404.352

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-1372-BK-FC	Student's Statement Regarding School Attendance	SSA-1372-bk-fc (revised).pdf		No		Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,198

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,198	1,048	150
Annual IC Time Burden (Hours)	60	52	8
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Current Version SSA-1372-BK-FC	ssa-1372-bk-fc.pdf	04/18/2017

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