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SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government
Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance
OMB: 0960-0105
IC ID: 182804
OMB.report
SSA
OMB 0960-0105
ICR 202406-0960-005
IC 182804
( )
Documents and Forms
Document Name
Document Type
Form SSA-1372-BK-FC
SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government
Form
0105 Privacy Act Statement (revised).docx
Other-Revised Privacy Act Statement
0105 Privacy Act Statement (revised).docx
Other-Revised Privacy Act Statement
PRA 0105.docx
Other-Revised Paperwork Reduction Ac
PRA 0105.docx
Other-Revised Paperwork Reduction Ac
SSA-1372-BK-FC Student's Statement Regarding School Attendance
SSA-1372-BK-FC (revised).pdf
Form
SSA-1372-BK-FC Student's Statement Regarding School Attendance
SSA-1372-BK-FC (revised).pdf
Form
SSA-1372-BK-FC (current).pdf
SSA-1372-BK-FC - Current
IC Document
SSA-1372-BK-FC (current).pdf
SSA-1372-BK-FC - Current
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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-FC
Student's Statement Regarding School Attendance
SSA-1372-BK-FC (revised).pdf
No
Fillable Printable
Other-Revised Privacy Act Statement
0105 Privacy Act Statement (revised).docx
No
Paper Only
Other-Revised Paperwork Reduction Act
PRA 0105.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:
746
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
746
0
0
0
0
746
Annual IC Time Burden (Hours)
124
0
0
0
0
124
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA-1372-BK-FC - Current
SSA-1372-BK-FC (current).pdf
08/25/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.