Information Collection

SSA-1372-BK (Domestic)--State/Local/Tribal Government

IC 182786 under ICR 202604-0960-005 · OMB 0960-0105.

Documents and Forms

Document Name Document Type
Form SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK (Domestic)--State/Local/Tribal Government Form
SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSA-1372-BK (Domestic)--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 404.367-404.368 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.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: 216,593	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	216,593	-16,586	233,179
Annual IC Time Burden (Hours)	72,198	33,335	38,863
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.

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