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Request for Reinstatement (Title II)
Request for Reinstatement (Title II)
OMB: 0960-0742
IC ID: 45431
OMB.report
SSA
OMB 0960-0742
ICR 202112-0960-004
IC 45431
( )
Documents and Forms
Document Name
Document Type
Form SSA-371
Request for Reinstatement (Title II)
Form
Privacy Act Statement 0742 (revised).docx
Other-Privacy Act Statement (revised
0742 PRA Statement (revised).docx
Other-Paperwork Reduction Act (revis
SSA-371 Request for Reinstatement - Title II
SSA-371 (revised).pdf
Form
SSA-371 (current).pdf
Current SSA-371
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Request for Reinstatement (Title II)
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 404.1592b - 404.1592f
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-371
Request for Reinstatement - Title II
SSA-371 (revised).pdf
No
Fillable Printable
Other-Privacy Act Statement (revised)
Privacy Act Statement 0742 (revised).docx
No
Paper Only
Other-Paperwork Reduction Act (revised)
0742 PRA Statement (revised).docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10,000
0
0
0
0
10,000
Annual IC Time Burden (Hours)
333
0
0
0
0
333
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Current SSA-371
SSA-371 (current).pdf
01/06/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.