SSA-1372-BK (Domestic)- Representative Payees

Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance

Documents and Forms

Document Name Document Type
Form SSA-1372-BK SSA-1372-BK (Domestic)- Representative Payees Form
SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK (revised).pdf Form
SSA-1372-BK Advanced Notice of Termination of Child's Benefits SSA-1372-BK (revised).pdf Form
SSA-1372-BK (current).pdf Advanced Notice of Termination of Child's Benefits IC Document
SSA-1372-BK (current).pdf Advanced Notice of Termination of Child's Benefits IC Document

Information Collection (IC) Details

IC Title:	SSA-1372-BK (Domestic)- Representative Payees	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-1372-BK	Advanced Notice of Termination of Child's Benefits	SSA-1372-BK (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: 23,318	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	23,318	23,318
Annual IC Time Burden (Hours)	5,830	5,830
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Advanced Notice of Termination of Child's Benefits	SSA-1372-BK (current).pdf	06/27/2024

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