Request for Reinstatement (Title II)

Request for Reinstatement (Title II)

OMB: 0960-0742

IC ID: 45431

Information Collection (IC) Details

View Information Collection (IC)

Request for Reinstatement (Title II)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 404.1592b - 404.1592f

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

Income Security General Retirement and Disability

 

10,000 0
   
Individuals or Households
 
   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

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.

© 2024 OMB.report | Privacy Policy