Information Collection

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

IC 9072 under ICR 200810-0960-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form SSA-1372-BK SSA-1372-BK (Domestic)--Individuals/Households Form
SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK--revised version.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-1372-BK (Domestic)--Individuals/Households	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 404.367-404.368 20 CFR 404.350-404.352

Information Collection 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 version.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: 99,850	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	99,850	0	99,850
Annual IC Time Burden (Hours)	13,313	-4,993	18,306
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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