Form SSA-1372-BK Advanced Notice of Termination of Child's Benefits

Form SSA-1372-BK (12-2017) UF
Discontinue Prior Editions
Social Security Administration

Page 1 of 7
OMB No. 0960-0105

ADVANCE NOTICE OF TERMINATION OF CHILD'S BENEFITS
NAME AND ADDRESS

SOCIAL SECURITY CLAIM NUMBER

NAME OF CHILD BENEFICIARY TO WHOM THIS
STATEMENT APPLIES

DATE CHILD ATTAINS AGE 18

YOUR BENEFITS WILL AUTOMATICALLY STOP AT AGE 18 UNLESS:
●

You are a full-time student at an elementary or secondary school (a
secondary school is a school at or below the high school level), or

●

You qualify for childhood disability benefits.

Your benefits will end with the payment for the month before the month in which you attain age 18. You attain
age 18 on the day before your 18th birthday. This is important when your birthday is on the first day of the
month. For example, if your 18th birthday is June 1, you attain that age on May 31. If you are neither a full-time
student nor disabled in May, benefits would not be payable for May. The last benefit check to which you would
be entitled would be the one received in May, which represents your payment for April.

FOR YOU TO RECEIVE STUDENT BENEFITS AFTER AGE 18, YOU MUST:
1.

Complete the form, STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE (page 2).

2.

Take the form to the school for a school official to certify on page 3 the information you provide
on page 2.

3.

Leave page 4, NOTICE OF CESSATION OF FULL-TIME SCHOOL ATTENDANCE, and page 5 with
the school official.

4.

Bring pages 2 (STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE) and 3
(CERTIFICATION BY SCHOOL OFFICIAL) to a Social Security office or return them in the enclosed
envelope (fold page 2 so the address on back shows through window envelope) prior to the age
18 attainment month shown above.

5.

For Direct Deposit, bring or mail a voided check or a copy of a bank statement. Your name must
be on the account.

TO RECEIVE CHILDHOOD DISABILITY BENEFITS, YOU MUST CONTACT ANY
SOCIAL SECURITY OFFICE AND HAVE THE FOLLOWING INFORMATION:
1.

A history of the disabling condition, including names and addresses of medical record sources
(such as doctors and hospitals) and schools attended. If you have worked, you must also furnish
your work history.

2.

Your Social Security Number.

Please keep the attached sheet, INFORMATION ABOUT BENEFITS PAST AGE 18 (page 6), for your
records. It contains important information about eligibility for student benefits and reporting responsibilities.

Form SSA-1372-BK (12-2017) UF
Discontinue Prior Editions
Social Security Administration
STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE
NAME AND ADDRESS

The information requested on this form is sought pursuant to
authority granted by law (42 U.S.C. 402 and 405). While you
are not required to respond, your cooperation is needed to
confirm your past and/or continuing entitlement to
student benefits.
SOCIAL SECURITY CLAIM NUMBER
1.

Page 2 of 7
OMB No. 0960-0105

(For a change or correction of address, line through the old
address and insert the new address.)

Current School Attendance
(a) Are you now in full-time attendance?

Yes
No (NOTE: If you are completing this form during a summer break period and you
were in full-time attendance prior to the break and will continue school in the fall, you should answer YES to question 1(a). You should show the
beginning date of the fall semester for question 1(b). See question 2 for past school attendance information.)
School Year Began
Month, Day, Year

(b) Print School's Name and Address

(c) Type of School Program

High School

Home School

GED

Technical

School Year Will End
Month, Day, Year

Vocational

Other (Specify):
Hours

(d) Show the number of hours per week you are scheduled to attend

Month,Year

(e) Show your EXPECTED graduation date from SECONDARY school (e.g., high school)

2.

(f) What months between now and your expected graduation will you not be in fulltime attendance for the full month? (For example, months of summer vacation)
Last School Year
PAST DATES OF ATTENDANCE
(a) Print School's Name and Address
School Year Began
School Year Ended
Month, Day, Year
Month, Day, Year

(b) Type of School Program

High School

Home School

GED

Vocational

Technical

Other (Specify):
Hours

(c) Show the number of hours per week you were scheduled to attend
3.

Are you disabled?

Yes

No

4.

Are you married?

Yes

No

5.

(a) Do you expect to earn more than

Month, Day, Year

(If yes, show the date you were married)
?

in year

?$

(b) If YES, how much do you expect your total earnings to be in year
(c) Enter the first month you expect to earn over
in year
6.
7.

Are you being paid by your employer to attend school?
Do you have a bank account?

Yes

Yes

Yes

No
Month, Year

No

No

(If yes, attach a voided check or copy of a savings account statement to this form. Student's name must be on the account.)

Do you have an unsatisfied warrant for your arrest for a crime or attempted crime of flight to avoid prosecution or
confinement or escape from custody?
No
Yes
I understand that SSA will use the earnings reported to SSA by my employer(s) and my self-employment tax return (if applicable)
as the report of earnings required by law and adjust benefits under the earnings test. I also understand that it is my responsibility
to ensure that the information I give SSA concerning my earnings is correct. I also understand that I must furnish additional
information as needed when my benefit adjustment is not correct based on the earnings on my record.
8.

I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or
forms, and it is true and correct to the best of my knowledge. I understand that anyone who knowingly gives a false or misleading
statement about a material fact in this information, or causes someone else to do so, commits a crime and may be sent to prison,
or may face other penalties, or both. I also certify that I have read the detachable information sheet. I authorize my school to
disclose to the Social Security Administration any information concerning my status as a student as it pertains to past, current, or
future Social Security student benefits.

SIGNATURE OF STUDENT
Signature (First Name, Middle Initial, Last Name (Write in ink))

Student's Own Social Security Number

Mailing Address

Telephone Number (with area code)

Date

Form SSA-1372-BK (12-2017) UF

Page 3 of 7

CERTIFICATION BY SCHOOL OFFICIAL
Name of Student

Social Security Claim Number

Please review the information the student provided on page 2, answer the questions below, annotate the student's
expected graduation date on page 4, and sign and date the form in the space provided. You should give pages 2
and 3 to the student to return to the Social Security Administration. Please retain page 4 for reporting if the student's
full-time attendance ends, or the student graduates, before the date indicated.
1) All information entered in items 1 and 2 of page 2 is correct according to the school's records.
Yes

No

2) Is the school's course of study at least 13 weeks in duration?
Yes

No

3) Please indicate which of the following applies to the school's operating basis.
Yearly
Quarterly/Semester - No Reenrollment Required
Quarterly/Semester - Reenrollment Required

4) I received pages 4 and 5 of this form for reporting changes in the student's attendance.
Yes

No

5) I annotated page 4 of this form with the student's expected graduation date as reported on page 2 of this form.
Yes

No

I declare under penalty of perjury that I have examined all the information on this form, and on any
accompanying statements or forms, and it is true and correct to the best of my knowledge.
School
Official
Signs

Title

Printed Name
Date

Phone Number (with area code)

The people in your Social Security office will be glad to help you with any questions concerning this form or any
other questions you have about Social Security. For more information, please see:
www.socialsecurity.gov/schoolofficials/.

Form SSA-1372-BK (12-2017) UF

Page 4 of 7

SCHOOL SHOULD DETACH AND RETAIN THIS FORM
Field Office Name and Address

NOTICE OF CESSATION OF FULL-TIME SCHOOL ATTENDANCE
NAME OF SOCIAL SECURITY BENEFICIARY

DATE OF BIRTH

SOCIAL SECURITY CLAIM NUMBER

STUDENT'S SOCIAL SECURITY NUMBER STUDENT'S EXPECTED

MONTH, YEAR

GRADUATION DATE
(FROM PAGE 2)
INDIVIDUAL IDENTIFIED ABOVE CEASED TO BE A FULL-TIME STUDENT AT THIS SCHOOL ON (MONTH, DAY, YEAR)

REASON:
1.
2.
3.
4.

Withdrawal, suspension, or expulsion
Changed to part-time status
Failed to continue in full-time attendance at start of new term (or new school year)
Other (Explain)

NAME AND ADDRESS OF SCHOOL

I declare under penalty of perjury that I have examined all the information on this form, and on any
accompanying statements or forms, and it is true and correct to the best of my knowledge.
SIGNATURE (OR FACSIMILE) OF SCHOOL OFFICIAL

PRINTED NAME

TITLE

DATE

IMPORTANT INFORMATION ABOUT THIS FORM
This form contains the name, date of birth, and Social Security claim number of a child beneficiary who tells us that he/she
is (or will be when school resumes) a full-time student at your school. One of the conditions a child between 18 and 19
must meet to receive Social Security benefits is that he/she be a full-time student.
Full-Time Attendance
For Social Security purposes, a student in “full-time attendance” is one who is attending an elementary or secondary
school and is enrolled in a day or evening non-correspondence course at least 13 weeks in duration. In addition, the
student must be scheduled to attend at the rate of at least 20 hours weekly and be carrying a subject load that is
considered full-time for day students under the school's standards and practices. If there is any question about whether a
student's attendance is full or part-time, please apply your school's usual criteria.
What to Report
Please hold this form until the student is no longer a full-time student at your school (whether this is during the current
school year, at the start of the next school year, or any time after that). Then, enter the date he/she stopped being a fulltime student, check the appropriate box above and return the completed form to the Social Security office shown above.
You should not return the form to report that attendance stopped for a scheduled break (e.g., summer break) unless you
do not expect the student to return after the break. You should report if the student stops attending school full-time,
or graduates earlier than the expected graduation date shown above. The people in your Social Security office will be
glad to help you with any questions concerning this form or any other questions you have about Social Security. For more
information, please see: www.socialsecurity.gov/schoolofficials/.
Thanks for your cooperation..

Form SSA-1372-BK (12-2017) UF

Page 5 of 7

Privacy Act Statement
Collection and Use of Personal Information

See Revised
Privacy
Sections 202(d) and 205(a) of the Social Security Act, as amended, allow us to
collectAct
this information.
Statement
Furnishing us this information is voluntary. However, failing to provide all or part of the information may
prevent an accurate and timely decision on your claim.
We will use the information to verify your school attendance and eligibility for student benefits. We may
also share your information for the following purposes, called routine uses:
1. To third party contacts where necessary to establish or verify information provided by
representative payees or payee applicants; and
2. To applicants, claimants, prospective applicants or claimants, other than the data subject,
their authorized representative payees to the extent necessary to pursue Social Security
claims and to representative payees when the information pertains to individuals for whom
they serve as representative payees, for the purpose of assisting SSA in administering its
representative payment responsibilities under the Social Security Act and assisting the
representative payees in performing their duties as payees, including receiving and
accounting for benefits for individuals for whom they serve as payees.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws.
For example, where authorized, we may use and disclose this information in computer matching
programs, in which our records are compared with other records to establish or verify a person’s
eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these
programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN)
60-0089, entitled Claims Folders System. Additional information and a full listing of all our SORNs are
available on our website at www.socialsecurity.gov/foia/bluebook.
See Revised PRA
the requirements of 44 U.S.
Paperwork Reduction Act Statement - This information collection meets
Statement
C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to
answer these questions unless we display a valid Office of Management and Budget (OMB) control
number. We estimate that it will take about 3 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments relating to our time estimate above to: SSA, 6401
Security Blvd, Baltimore, MD 21235-6401.

Form SSA-1372-BK (12-2017) UF

Page 6 of 7

STUDENT SHOULD DETACH AND KEEP THIS INFORMATION FOR FUTURE REFERENCE

INFORMATION ABOUT BENEFITS PAST AGE 18
If you qualify for Social Security benefits because you are a full-time student, you can start receiving benefits as
early as age 18 and usually through the month you graduate from secondary school, or the month before age 19,
whichever is earlier. Your benefits will be paid in your own name beginning at age 18, either by direct deposit or by
mail. Generally, we consider you to be a full-time student if you are in full-time attendance at a school that provides
education at the secondary (grade 12) level or below. Full-time attendance means you are scheduled to attend
classes at the rate of 20 hours per week, or at the rate determined by your school to be full-time (if higher).

INFORMATION ABOUT BENEFITS PAST AGE 19
Your benefits may continue past age 19 if you are in actual full-time attendance at a school that provides
elementary or secondary education in the month you become age 19. If the school operates on a yearly basis,
then payment may be continued after age 19 up through the earlier of (1) the month you complete the course in
which you are enrolled full-time or (2) the second month after the month you become age 19. If the school requires
re-enrollment on other than a yearly basis, benefits may continue through the month ending the term that is in
progress when you become age 19. Note that payments beyond age 19 cannot be made if you become age 19 in
a month of nonattendance (for example, you become age 19 in a month when you are on summer vacation).

IMPORTANT RESPONSIBILITIES
YOU MUST NOTIFY THE SOCIAL SECURITY ADMINISTRATION PROMPTLY IF:
●

YOU MARRY

●

YOU STOP ATTENDING SCHOOL

●

YOU REDUCE YOUR SCHOOL ATTENDANCE BELOW FULL-TIME

●

YOU CHANGE SCHOOLS

●

YOU ARE PAID BY YOUR EMPLOYER TO ATTEND SCHOOL (at the request of or as a requirement of
your employer)

●

YOU HAVE AN UNSATISFIED WARRANT FOR YOUR ARREST FOR A CRIME OR AN ATTEMPTED
CRIME FOR FLIGHT TO AVOID PROSECUTION OR CONFINEMENT OR ESCAPE FROM CUSTODY

Your benefits may end if any of the above occur. You must report each of these events even if you
believe your benefits should not end. We will tell you about how your benefits may be affected.
YOU SHOULD ALSO NOTIFY THE SOCIAL SECURITY ADMINISTRATION PROMPTLY IF:
●

YOU MOVE OR CHANGE YOUR MAILING ADDRESS

●

YOUR ESTIMATED EARNINGS FROM WORK CHANGE

When you are awarded Social Security benefits as a student, you will receive a booklet
that further covers your responsibilities. It is important for you to read that booklet.

Form SSA-1372-BK (12-2017) UF

Page 7 of 7

Privacy Act Statement
Collection and Use of Personal Information
Sections 202(d) and 205(a) of the Social Security Act, as amended, allow us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the information may
prevent an accurate and timely decision on your claim.
We will use the information to verify your school attendance and eligibility for student benefits. We may
also share your information for the following purposes, called routine uses:
1. To third party contacts where necessary to establish or verify information provided by
representative payees or payee applicants; and
2. To applicants, claimants, prospective applicants or claimants, other than the data subject,
their authorized representative payees to the extent necessary to pursue Social Security
claims and to representative payees when the information pertains to individuals for whom
they serve as representative payees, for the purpose of assisting SSA in administering its
representative payment responsibilities under the Social Security Act and assisting the
representative payees in performing their duties as payees, including receiving and
accounting for benefits for individuals for whom they serve as payees.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws.
For example, where authorized, we may use and disclose this information in computer matching
programs, in which our records are compared with other records to establish or verify a person’s
eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these
programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN)
60-0089, entitled Claims Folders System. Additional information and a full listing of all our SORNs are
available on our website at www.socialsecurity.gov/foia/bluebook.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.
C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to
answer these questions unless we display a valid Office of Management and Budget (OMB) control
number. We estimate that it will take about 3 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments relating to our time estimate above to: SSA, 6401
Security Blvd, Baltimore, MD 21235-6401.