Request for Reinstatement (Title XVI)

ICR 201511-0960-014

OMB: 0960-0744

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2016-02-01
Supplementary Document
2015-11-19
IC Document Collections
IC ID
Document
Title
Status
45441 Modified
ICR Details
0960-0744 201511-0960-014
Historical Active 201208-0960-008
SSA
Request for Reinstatement (Title XVI)
Revision of a currently approved collection   No
Regular
Approved without change 03/25/2016
Retrieve Notice of Action (NOA) 02/08/2016
  Inventory as of this Action Requested Previously Approved
03/31/2019 36 Months From Approved 03/31/2016
2,000 0 2,000
67 0 67
0 0 0

SSA uses Form SSA-372 to inform previously entitled beneficiaries of the EXR requirements, and to document their requests for EXR. We require 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, the claims representative gives or mails, the form to the previously entitled individuals if they 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.

US Code: 42 USC 223(i) Name of Law: The Social Security Act
  
None

Not associated with rulemaking

  80 FR 66967 10/30/2015
81 FR 2938 01/19/2016
No

1
IC Title Form No. Form Name
Request for Reinstatement (Title XVI) SSA-372 Request for Reinstatement -- Title XVI

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,000 2,000 0 0 0 0
Annual Time Burden (Hours) 67 67 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$4,620
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 faye.lipsky@ssa.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/08/2016


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