Request for Reinstatement (Title II)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-371 Request for Reinstatement - Title II	Form	Modified	Repair queued
Form SSA-371 Request for Reinstatement (Title II)	Form	Modified	Repair queued
Supporting Statement - 0742 (Final).docx	Supporting Statement A	Uploaded 2022-01-12	Repair queued
Addendum 0742 (final).docx	Supplementary Document	Uploaded 2022-01-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45431	Request for Reinstatement (Title II)	Form	Modified	Request for Reinstatement - Title II
45431	Request for Reinstatement (Title II)	Form	Modified
45431	Request for Reinstatement (Title II)	Other-Privacy Act Statement (revised)	Modified

ICR Details

OMB Control No: 0960-0742	ICR Reference No: 202112-0960-004
Status: Active	Previous ICR Reference No: 201807-0960-005
Agency/Subagency: SSA	Agency Tracking No:
Title: Request for Reinstatement (Title II)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/01/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/12/2022
Terms of Clearance: The agency revised the Supporting Statement A to provide greater detail regarding how the information is collected and subsequent steps after submission of information. The agency also revised the burden estimate. Prior to triannual renewal, the agency should ensure this information collection is included in the Document Upload or a successor online platform.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2027	36 Months From Approved	04/30/2024
Responses	10,000	0	10,000
Time Burden (Hours)	9,333	0	333
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 42 USC 423 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 56746	10/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 139	01/03/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

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

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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)	9,333	333	0	0	9,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no changes to the public reporting burden. * Note: The total burden reflected in ROCIS is 9,333, while the burden cited in #12 above is 833. This discrepancy is because the ROCIS burden reflects the following components: field office waiting time + telephone call system wait times + a rough estimate of a 30-minute, one-way, drive burden. In contrast, the chart in #12 above reflects actual burden.

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Annual Cost to Federal Government: $27,224

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/12/2022

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