Information Collection

SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government

IC 182804 under ICR 201009-0960-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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-FC SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government Form
SSA-1372-BK-FC Student's Statement Regarding School Attendance SSA-1372-BK-FC - Revised Version.pdf Form
SSA-1372-BK-FC - Current Version.pdf Current SSA-1372-BK-FC IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government	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 404.350-404.352 20 CFR 404.367-404.368

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1372-BK-FC	Student's Statement Regarding School Attendance	SSA-1372-BK-FC - 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: 150	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-1372-BK-FC	SSA-1372-BK-FC - Current Version.pdf	12/22/2010

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