Request for Reinstatement (Title XVI)

Documents and Forms

Document Name Document Type
Form SSA-372 Request for Reinstatement (Title XVI) Form
SSA-372 Request for Reinstatement -- Title XVI SSA-372 (revised).pdf Form
SSA-372 (current).pdf Current SSA-372 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Reinstatement (Title XVI)	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 416.999 - 416.999d

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-372	Request for Reinstatement -- Title XVI	SSA-372 (revised).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: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	0	2,000
Annual IC Time Burden (Hours)	1,767	1,700	67
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-372	SSA-372 (current).pdf	05/24/2022

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