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

Form Approved
SOCIAL SECURITY ADMINISTRATION
OMB No. 0960-0105
____________________________________________________________________________________________________________

ADVANCE NOTICE OF TERMINATION OF CHILD’S BENEFITS
_________________________________________________________
NAME AND ADDRESS

| SOCIAL SECURITY CLAIM 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 BENEFITS AFTER AGE 18, YOU MUST:
1.
2.
3.
4.

5.

Complete the form, STUDENT’S STATEMENT REGARDING SCHOOL ATTENDANCE
(page 2).
Take the form to the school for a school official to certify on page 3 the information you
provide on page 2.
Leave page 4, NOTICE OF CESSATION OF FULL-TIME SCHOOL ATTENDANCE, and
page 5 with the school official.
Bring pages 2 (STUDENT’S STATEMENT REGARDING SCHOOL ATTENDANCE)
and 3 (CERTIFICATION BY SCHOOL OFFICIAL) to a Social Security office or return them in
the enclosed envelope (fold page 2 so the address on back shows through window envelope)
prior to the age 18 attainment month shown above.
For Direct Deposit, bring or mail a voided check or a copy of a bank statement. Your name
must be on the account.

NOTE: If you mail the form, a Social Security representative will contact you to discuss your rights and responsibilities as a student.
This discussion must take place before we can process your student award.
TO RECEIVE CHILDHOOD DISABILITY BENEFITS, YOU MUST CONTACT ANY SOCIAL SECURITY OFFICE AND HAVE
THE FOLLOWING INFORMATION:
1.

2.

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.
Your Social Security number.

Please keep the attached sheet, INFORMATION ABOUT BENEFITS PAST AGE 18 (page 6), for your records. It contains important
information about eligibility for student benefits and reporting responsibilities.
_____________________________________________________________________________________
Form SSA-1372-BK (00-2007)
Destroy Prior Editions
Page 1

Form Approved
SOCIAL SECURITY ADMINISTRATION
OMB No. 0960-0105
______________________________________________________________________________________________________________________________

STUDENT’S STATEMENT REGARDING SCHOOL ATTENDANCE
_____________________________________________________________________________________________________
The information requested on this form is sought pursuant to authority | NAME AND ADDRESS
granted by law (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
| (For a change or correction of address, line through the old address and insert the new
| address.)
_____________________________________________________________________________________________________________________________
1. 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 you were 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
| School Year Began |
School Year Will End
|Month, Day, Year |
Month, Day, Year
|________________________________________________
|
________________________________________________________________________________ |_________________________________________________
(c) Type of School Program
 High School  Home School
 GED
 Technical
 Vocational
 Other (Specify):
__________________________________________________________________________________________________________________________________
(d) Show the number of hours per week you are scheduled to attend
| Hours
----------------------------------------→
|
___________________________________________________________________________________________________________________________________
(e) Show your EXPECTED graduation date from SECONDARY school (e.g., high school)
| Month, Year
|
____________________________________________________________________________________________________________________________________
(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
_________________________________________________________________________________|___________________________________________________
(a) Print School’s Name and Address
| School Year Began
| School Year Ended
| Month, Day, Year
| Month, Day, Year
____________________________________________________
|
|
|
|
_____________________________________________________________________________________________________________________________________
(b) Type of School Program
 High School  Home School  GED
 Technical
 Vocational
 Other (Specify):
__________________________________________________________________________________________________________________________________
(c) Show the number of hours per week you are scheduled to attend
| Hours
----------------------------------------→
|
___________________________________________________________________________________________________________________________________
3. Are you disabled?
 Yes
 No
___________________________________________________________________________________________________________________________________
4. Are you married?
 Yes
 No
(If yes, show the date you were married.)------------------→
| Month, Day, Year
|________________________
|
____________________________________________________________________________________________________________|________________________
5. (a) Do you expect to earn more than _______________ in year ____________ ?
 Yes
 No
(b) If YES, how much do you expect your total earnings to be in year ______________?
$ _________________
(c) Enter the first month you expect to earn over _____________ in year _____________. --------------------→
| Month, Day, Year
|_______________
|
____________________________________________________________________________________________________________________________
6. Are you being paid by your employer to attend school?
 Yes
 No
____________________________________________________________________________________________________________________________
7. Do you have a bank account?
 Yes
 No
(If yes, attach a voided check or copy of a savings account statement to this form. Student’s name must be on the account.)
_______________________________________________________________________________________________________________________________
8. Do you have any unsatisfied felony warrants for your arrest?
 Yes
 No
________________________________________________________________________________________________________________________________
9. Do you have any unsatisfied Federal or State warrants for your arrest for violating the conditions of your probation or parole?
 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
______________________________________________________________________________________________________________________________________
First Name, Middle Initial, Last Name (Write in Ink)
| Mailing Address
|
SIGN
|
|
---→ |
|
HERE
|
|
________________________________________________________________________________________________________________________________________
Student’s Own Social Security Number
| Telephone Number (with area code)
|
_______________________________________________________________________________________________________________________________________
Form SSA-1372-BK (00-2007)
Page 2

SOCIAL SECURITY ADMINISTRATION

Form Approved
OMB No. 0960-0105

_____________________________________________________________________________________

CERTIFICATION BY SCHOOL OFFICIAL
_______________________________________________________________________
Name of Student
|Social Security Claim Number
|
____________________________________
|___________________________________
Please review the information the student provided on page 2, answer the questions below, annotate the student’s expected
graduation date on page 4, and sign and date the form in the space provided. You should give pages 2 and 3 to the student to
return to the Social Security Administration. Please retain page 4 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
□ No
2) Is the school’s course of study at least 13 weeks in duration?
□ Yes
□ No
3) 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 4 and 5 of this form for reporting changes in the student’s attendance.
□ Yes
□ No
5) I annotated page 4 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) __________________

Form SSA-1372-BK (00-2007) EF (00-2007)
Page 3

SCHOOL SHOULD DETACH AND RETAIN THIS FORM
SOCIAL SECURITY ADMINISTRATION

Field Office Name and Address

Form Approved
OMB No. 0960-0105

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 GRADUATION
| DATE (FROM PAGE 2) (MONTH, YEAR)
|
________________________________________________________________________________________________________
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

____________________________________________________________________________________________________________
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 you 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/ .
Thank you for your cooperation.
Form SSA-1372-BK (00-2007) EF (00-2007)
Page 4

PRIVACY ACT/PAPERWORK REDUCTION ACT NOTICE
The Social Security Administration is authorized to collect information about school attendance under sections 202(d)
and 205(a) of the Social Security Act, as amended (42 U.S.C. 402 and 405). While completing this form is voluntary,
failure to provide all or part of this information is cause for suspension of benefit payments. The information on this
form may be disclosed by the Social Security Administration to another person or agency for the following purposes:
(1) to assist the Social Security Administration in establishing the student’s right to Social Security benefits, (2) to
help with statistical research and audits necessary to assure the integrity and improvement of the Social Security
programs, and (3) to comply with laws requiring or allowing the exchange of information between the Social Security
Administration and another agency. This information will be used to verify full-time attendance in school and to
determine continuing eligibility to student benefits.
We may also use the information you give us when we match records by computer. Matching programs compare our
records with those of other Federal, State, or local government agencies. Many agencies may use matching programs
to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even
if you do not agree to it.
Explanations about these and other reasons why information you give us may be used or given out are available in
Social Security offices. If you want to learn more about this, contact any Social Security office.
PAPERWORK REDUCTION ACT: 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 control number. We estimate that it will take about 11 minutes to
read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM
TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in
your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may
send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only
comments relating to our time estimate to this address, not the completed form.

Form SSA-1372-BK (00-2007)

Page 5

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 or the 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 ANY UNSATISFIED FELONY WARRANTS FOR YOUR ARREST
• YOU HAVE ANY UNSATISFIED FEDERAL OR STATE WARRANTS FOR YOUR ARREST FOR VIOLATING THE
CONDITIONS OF YOUR PROBATION OR PAROLE

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 (00-2007)

Page 6

PRIVACY ACT/PAPERWORK REDUCTION ACT NOTICE
The Social Security Administration is authorized to collect information about school attendance under sections 202(d)
and 205(a) of the Social Security Act, as amended (42 U.S.C. 402 and 405). While completing this form is voluntary,
failure to provide all or part of this information is cause for suspension of benefit payments. The information on this
form may be disclosed by the Social Security Administration to another person or agency for the following purposes:
(1) to assist the Social Security Administration in establishing your right to Social Security benefits, (2) to help with
statistical research and audits necessary to assure the integrity and improvement of the Social Security programs, and
(3) to comply with laws requiring or allowing the exchange of information between the Social Security
Administration and another agency. This information will be used to verify full-time attendance in school and to
determine continuing eligibility to student benefits.
We may also use the information you give us when we match records by computer. Matching programs compare our
records with those of other Federal, State, or local government agencies. Many agencies may use matching programs
to find or prove that a person qualifies for benefits paid by the Federal government. The law allows us to do this even
if you do not agree to it.
Explanations about these and other reasons why information you give us may be used or given out are available in
Social Security offices. If you want to learn more about this, contact any Social Security office.
PAPERWORK REDUCTION ACT: 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 control number. We estimate that it will take about 11 minutes to
read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM
TO YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in
your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may
send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only
comments relating to our time estimate to this address, not the completed form.

Form SSA-1372-BK (00-2007)

Page 7