Information Collection

SSA-1372-BK (Domestic)- Representative Payees

IC 243294 under ICR 202406-0960-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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 SSA-1372-BK (Domestic)- Representative Payees	Form
SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK (revised).pdf	Form
SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK (revised).pdf	Form
SSA-1372-BK (current).pdf Advanced Notice of Termination of Child's Benefits	IC Document
SSA-1372-BK (current).pdf Advanced Notice of Termination of Child's Benefits	IC Document

IC Title:

SSA-1372-BK (Domestic)- Representative Payees

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
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: 23,318

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	23,318	23,318
Annual IC Time Burden (Hours)	5,830	5,830
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Advanced Notice of Termination of Child's Benefits	SSA-1372-BK (current).pdf	06/27/2024

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