Request for Reinstatement (Title XVI)

SSA uses Form SSA-372 to: (1) inform previously entitled beneficiaries of the EXR requirements of SSI payments under Title XVI of the Act, and (2) to document their requests for EXR. SSA requires this application for reinstatement of benefits for respondents to obtain SSI disability payments for EXR. When an SSA claims representative learns of individuals whose medical conditions no longer permit them to perform SGA as defined in the Act, the claims representative gives or mails the paper Form SSA-372 to the previously entitled individuals (or mails it to those who request EXR over the phone). SSA employees collect this information whenever an individual files for EXR benefits. The respondents are applicants for EXR of SSI disability payments. We are making one change to the form due to a legislation: On September 15, 2017, the President signed into law H.R. 624, the Social Security Number Fraud Prevention Act of 2017, which became Public Law No. 115-59. The law restricts the inclusion of Social Security Numbers (SSN) on documents sent by mail by the Federal Government. Therefore, we updated the form to comply with the new law to reflect the BNC# in place of the SSN. We reflected this change in an Addendum. This change does not affect the public reporting burden.

The latest form for Request for Reinstatement (Title XVI) expires 2022-06-30 and can be found here.