Information Collection

SSA-1372-BK (Domestic)- Students

IC 9072 under ICR 202005-0960-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Advanced Notice of Termination of Child's Benefits SSA-1372-BK (Domestic)- Students	Form
0105 Privacy Act Statement (revised).docx	Other-Revised Privacy Act Statement
PRA 0105.docx	Other-Revised Paperwork Reduction Ac
SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK (revised).pdf	Form
SSA-1372-BK (current).pdf Advance Notice of Termincaiton fo Child's Benefits (current)	IC Document

IC Title:

SSA-1372-BK (Domestic)- Students

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	Available Electronically?	Electronic Capability
Other-Revised Privacy Act Statement			0105 Privacy Act Statement (revised).docx	No	Paper Only
Other-Revised Paperwork Reduction Act			PRA 0105.docx	No	Paper Only
Form	SSA-1372-BK	Advanced Notice of Termination of Child's Benefits	SSA-1372-BK (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: 233,179

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	233,179	133,329	99,850
Annual IC Time Burden (Hours)	31,091	17,778	13,313
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Advance Notice of Termincaiton fo Child's Benefits (current)	SSA-1372-BK (current).pdf	08/25/2020

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