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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201312-0960-001 · OMB 0960-0105 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-1372-BK SSA-1372-BK (Domestic)--Individuals/Households Form Modified Available
Form SSA-1372-BK-FC SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government Form Modified Repair queued
Form SSA-1372-BK-FC SSA-1372-FC (Foreign Claims)--Individuals/Households Form Modified Available
Form SSA-1372-BK SSA-1372-BK (Domestic)--State/Local/Tribal Government Form Modified Repair queued
Supporting Statement 0960-0105.doc Supporting Statement A Uploaded 2014-03-07 Repair queued
Addendum to the Supporting Statement 0960-0105.doc Supplementary Document Uploaded 2014-01-02 Available
IC Document Collections
IC IDCollectionTypeStatusForm
9072 SSA-1372-BK (Domestic)--Individuals/Households Form Modified
182804 SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government Form Modified
182797 SSA-1372-FC (Foreign Claims)--Individuals/Households Form Modified
182786 SSA-1372-BK (Domestic)--State/Local/Tribal Government Form Modified
ICR Details
0960-0105 201312-0960-001
Historical Active 201111-0960-015
SSA
Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance
Revision of a currently approved collection   No
Regular
Approved without change 06/13/2014
Retrieve Notice of Action (NOA) 03/10/2014
  Inventory as of this Action Requested Previously Approved
06/30/2017 36 Months From Approved 06/30/2014
200,000 0 200,000
18,334 0 18,334
0 0 0
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.
US Code: 42 USC 402 Name of Law: Social Security Act
  
None
Not associated with rulemaking
  78 FR 76378 12/17/2013
79 FR 11852 03/03/2014
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200,000 200,000 0 0 0 0
Annual Time Burden (Hours) 18,334 18,334 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$1,232,000
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/10/2014