Request for Reinstatement (Title XVI)

Request for Reinstatement (Title XVI)

OMB: 0960-0744

IC ID: 45441

Information Collection (IC) Details

View Information Collection (IC)

Request for Reinstatement (Title XVI)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.999 - 416.999d

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 - Revised.pdf No   Paper Only
Other-0744 Privacy Act Statement (revised) PA Statement SSA-372 (revised).docx No   Paper Only

Income Security General Retirement and Disability

 

2,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 67 0 0 0 0 67
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-372 SSA-372 (current).pdf 03/12/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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