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

Form SSA-1372-BK (XX-2024) UF
Discontinue Prior Editions
Social Security Administration

Page 1 of 8
OMB No. 0960-0105

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

BNC 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 (pages 2 & 3).
2. Take the form to the school for a school official to certify on page 4 the information you provide
on pages 2 & 3.
3. Leave page 5, NOTICE OF CESSATION OF FULL-TIME SCHOOL ATTENDANCE, and page 6 with
the school official.
4. Bring pages 2 & 3 (STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE) and 4
(CERTIFICATION BY SCHOOL OFFICIAL) to a Social Security office or return them in the
enclosed envelope (fold pages 2 & 3 so the address on back shows through window envelope)
prior to the age 18 attainment month shown above.
5. For direct deposit, enroll through your financial institution, call Social Security's National 800
Number (1-800-772-1213), or contact a Social Security office.
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 7), for your
records. It contains important information about eligibility for student benefits and reporting responsibilities.

THIS PAGE LEFT
BLANK
INTENTIONALLY

Form SSA-1372-BK (XX-2024) UF
Discontinue Prior Editions
Social Security Administration

Page 2 of 8
OMB No. 0960-0105

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.

(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 youwere 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.)
(b) Print School's Name and Address

(c) Type of School Program

High School

School Year Began School Year Will
End Month, Year
Month, Year

Home School

GED

Technical

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)
(f) What months between now and your expected graduation will you not be
in full-time attendance for the full month? (For example, months of
summer vacation)
2.

Last School Year

PAST DATES OF ATTENDANCE
School Year
Began
Month, Year

(a) Print School's Name and Address
check if same as current school year

(b) Type of School Program

High School

Home School

GED

Technical

School Year
Ended
Month, Year

Vocational

Other (Specify):
Hours
(c) Show the number of hours per week you were scheduled to attend

Form SSA-1372-BK (XX-2024) UF

3.

Are you disabled?
Yes

4.
5.

Page 3 of 8

No

Are you married?
Yes
No

Month, Day, Year
(If yes, show the date you were married)

(a) Do you expect to earn more than

in year

(b) If YES, how much do you expect your total earnings to be in year

?

Yes

No

? $
Month, Year

(c) Enter the first month you expect to earn over
6.

Are you being paid by your employer to attend school?
Yes

7.

in year

No

Do you have a bank account?
Yes
No
(If yes, for direct deposit, enroll through your financial institution, call Social Security's National
800 Number (1-800-772-1213), or contact a Social Security office.

8.

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?
Yes

No

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.
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 (XX-2024) UF

Page 4 of 8

CERTIFICATION BY SCHOOL OFFICIAL
Name of Student

Social Security Claim Number

Please review the information the student provided on pages 2 & 3, answer the questions below, annotate
the student's expected graduation date on page 5, and sign and date the form in the space provided. You
should give pages 2 through 4 to the student to return to the Social Security Administration. Please retain
page 5 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

2.

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

3.

No. If "No," please provide correct information according to school records.

No

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 5 and 6 of this form for reporting changes in the student's attendance.
Yes
No

5.

I annotated page 5 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/.

THIS PAGE LEFT
BLANK
INTENTIONALLY

Page 5 of 8

Form SSA-1372-BK (XX-2024) UF

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. Withdrawal, suspension, or expulsion
2. Changed to part-time status
3. Failed to continue in full-time attendance at start of new term (or new school year)
4. 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
full-time 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.

Page 6 of 8

Form SSA-1372-BK (XX-2024) UF

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:
•

To third party contacts where necessary to establish or verify information provided by representative
payees or representative payee applicants; and

•

To claimants, prospective claimants (other than the data subject), and their authorized
representatives or representative payees, to the extent necessary to pursue Social Security claims;
to representative payees, when the information pertains to individuals for whom they serve as
representative payees, for the purpose of assisting us in administering representative payment
responsibilities under the Social Security Act; and to representative payees, for the purpose of
assisting them 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, as published in the Federal Register (FR) on October 31, 2019,
at 84 FR 58422. Additional information, and a full listing of all our SORNs, is available on our website
at www.ssa.gov/privacy.
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 10 to 15 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments regarding this burden estimate or any other aspect of this
collection, including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.

Page 7 of 8

Form SSA-1372-BK (XX-2024) UF

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 (XX-2024) UF

Page 8 of 8

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:
•

To third party contacts where necessary to establish or verify information provided by representative
payees or representative payee applicants; and

•

To claimants, prospective claimants (other than the data subject), and their authorized
representatives or representative payees, to the extent necessary to pursue Social Security claims;
to representative payees, when the information pertains to individuals for whom they serve as
representative payees, for the purpose of assisting us in administering representative payment
responsibilities under the Social Security Act; and to representative payees, for the purpose of
assisting them 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, as published in the Federal Register (FR) on October 31, 2019,
at 84 FR 58422. Additional information, and a full listing of all our SORNs, is available on our website
at www.ssa.gov/privacy.
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 10 to 15 minutes to read the instructions, gather the facts, and
answer the questions. Send only comments regarding this burden estimate or any other aspect of
this collection, including suggestions for reducing this burden to: SSA, 6401 Security Blvd, Baltimore,
MD 21235-6401.

THIS PAGE LEFT
BLANK
INTENTIONALLY

THIS PAGE LEFT
BLANK
INTENTIONALLY