Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance

OMB 0960-0105

SSA uses the information collected on Forms SSA-1372-BK and SSA-1372-BK-FC to determine whether children of an insured worker are eligible for student benefits. The data allows SSA to determine student entitlement and whether entitlement will end. The respondents are student claimants for Social Security benefits, their respective schools and, in some cases, their representative payees. This is a non-substantive Change Request to make minor language changes to the SSA-1372-BK-FC.

The latest form for Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SSA-1372-BK-FC SSA-1372-BK (Foreign)- Representative Payees Form
Form SSA-1372-BK SSA-1372-BK (Domestic)- Representative Payees Form
Form SSA-1372-BK-FC SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government Form
Form SSA-1372-BK-FC SSA-1372-FC (Foreign Claims)-Students Form
Form SSA-1372-BK SSA-1372-BK (Domestic)--State/Local/Tribal Government Form
Supporting Statement 0105.docx Supporting Statement A
Addendum 0105.docx Supplementary Document
SSA-1372-BK (Domestic)- Students Other-Revised Privacy Act Statement
SSA-1372-BK (Foreign)- Representative Payees Form
SSA-1372-BK (Domestic)- Representative Payees Form
SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government Form
SSA-1372-FC (Foreign Claims)-Students Form
SSA-1372-BK (Domestic)--State/Local/Tribal Government Form

All Historical Document Collections

202005-0960-003	Revision of a currently approved collection	2020-08-25
201803-0960-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2018-05-04
201701-0960-009 Approved without change	Revision of a currently approved collection	2017-05-01
201603-0960-008 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-03-16
201312-0960-001 Approved without change	Revision of a currently approved collection	2014-03-10
201111-0960-015 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-11-30
201009-0960-003 Approved without change	Revision of a currently approved collection	2011-02-04
200810-0960-010 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-10-20
200805-0960-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-05-07
200711-0960-004 Approved without change	Revision of a currently approved collection	2008-02-06
200509-0960-004 Approved without change	Revision of a currently approved collection	2005-09-16
200401-0960-004 Approved without change	Revision of a currently approved collection	2004-01-09
200011-0960-002 Approved without change	Revision of a currently approved collection	2000-11-09
199806-0960-010 Approved without change	Extension without change of a currently approved collection	1998-06-16
199505-0960-005 Approved without change	Revision of a currently approved collection	1995-05-19
199203-0960-006 Approved without change	Revision of a currently approved collection	1992-03-27
199103-0960-002 Approved without change	Revision of a currently approved collection	1991-03-04
199001-0960-003 Approved without change	Revision of a currently approved collection	1990-01-30
198709-0960-015 Approved with change	No material or nonsubstantive change to a currently approved collection	1987-09-01
198703-0960-005 Approved without change	Extension without change of a currently approved collection	1987-03-16
198404-0960-008 Approved without change	Revision of a currently approved collection	1984-04-20
198107-0960-007 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-07-17
198002-0960-001 Approved without change	Reinstatement with change of a previously approved collection	1980-02-26
197912-0960-006 Approved with change	No material or nonsubstantive change to a currently approved collection	1979-12-31
197909-0960-002 Approved with change	No material or nonsubstantive change to a currently approved collection	1979-09-28
197906-0960-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1979-06-26
197803-0960-002 Approved without change	Revision of a currently approved collection	1978-03-09
197803-0960-001 Approved without change	Revision of a currently approved collection	1978-03-09
197802-0960-002 Approved without change	Reinstatement with change of a previously approved collection	1978-02-28

OMB Details

SSA-1372-BK (Domestic)--Individuals/Households

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form SSA-1372-BK

Advanced Notice of Termination of Child's Benefits

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.