Request for Reinstatement (Title II)

ICR 202112-0960-004

OMB: 0960-0742

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2022-01-12
Supplementary Document
2022-01-06
IC Document Collections
IC ID
Document
Title
Status
45431 Modified
ICR Details
0960-0742 202112-0960-004
Received in OIRA 201807-0960-005
SSA
Request for Reinstatement (Title II)
Revision of a currently approved collection   No
Regular 01/12/2022
  Requested Previously Approved
36 Months From Approved 02/28/2022
10,000 10,000
333 333
0 0

SSA allows certain previously entitled disability beneficiaries to request expedited reinstatement (EXR) of benefits under Title II of the Social Security Act when their medical condition no longer permits them to perform substantial gainful activity. SSA uses Form SSA-371 to obtain: (1) A signed statement from individuals requesting an EXR of their Title II disability benefits, and (2) proof the requestors meet the EXR requirements. SSA maintains the form in the disability folder of the applicant to demonstrate the requestors’ awareness of the EXR requirements, and their choice to request EXR. Respondents are applicants for EXR of Title II disability benefits.

US Code: 42 USC 423 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  86 FR 56746 10/12/2021
87 FR 139 01/03/2022
No

1
IC Title Form No. Form Name
Request for Reinstatement (Title II) SSA-371 Request for Reinstatement - Title II

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10,000 10,000 0 0 0 0
Annual Time Burden (Hours) 333 333 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$27,224
No
    Yes
    Yes
No
No
No
No
Faye Lipsky 410 965-8783 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/12/2022


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