Request for Reinstatement (Title II)

Documents and Forms

Document Name Document Type
Form SSA-371 Request for Reinstatement (Title II) Form
Privacy Act Statement 0742 (revised).docx Other-Privacy Act Statement (revised
0742 PRA Statement (revised).docx Other-Paperwork Reduction Act (revis
SSA-371 Request for Reinstatement - Title II SSA-371 (revised).pdf Form
SSA-371 (current).pdf Current SSA-371 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Reinstatement (Title II)	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 404.1592b - 404.1592f

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-371	Request for Reinstatement - Title II	SSA-371 (revised).pdf	No	Fillable Printable
Other-Privacy Act Statement (revised)			Privacy Act Statement 0742 (revised).docx	No	Paper Only
Other-Paperwork Reduction Act (revised)			0742 PRA Statement (revised).docx	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-371	SSA-371 (current).pdf	01/06/2022

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