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

Forms and Documents

Document Name	Status
Form SSA-1372-BK SSA-1372-BK (Domestic)--Individuals/Households Form	Modified
Form SSA-1372-BK-FC SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government Form	New
Form SSA-1372-BK-FC SSA-1372-FC (Foreign Claims)--Individuals/Households Form	New
Form SSA-1372-BK SSA-1372-BK (Domestic)--State/Local/Tribal Government Form	New
Supporting_Statement--0105[1].doc Supporting Statement A	2008-02-04
SSA-1372-BK-FC--current version.pdf Supplementary Document	2007-11-23
SSA-1372-BK--current version.pdf Supplementary Document	2007-11-23
Addendum--0105.doc Supplementary Document	2008-02-04

IC Document Collections

IC ID	Document Title	Status
9072	SSA-1372-BK (Domestic)--Individuals/Households Form	Modified
182804	SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government Form	New
182797	SSA-1372-FC (Foreign Claims)--Individuals/Households Form	New
182786	SSA-1372-BK (Domestic)--State/Local/Tribal Government Form	New

ICR Details

OMB Control No: 0960-0105	ICR Reference No: 200711-0960-004
Status: Historical Active	Previous ICR Reference No: 200509-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Advanced Notice of Termination of Child's Benefits, and Student's Statement Regarding School Attendance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2008
	Date Received in OIRA: 02/06/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	11/30/2008
Responses	200,000	0	200,000
Time Burden (Hours)	36,666	0	33,333
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected on Forms SSA-1372-BK and SSA-1372-BK-FC is needed to determine whether children of an insured worker are eligible for student benefits. The data allows SSA to determine student entitlement and whether entitlement will end. The respondents are student claimants for Social Security benefits, their respective schools and, in some cases, their representative payees.

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Authorizing Statute(s): US Code: 42 USC 402 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 59133	10/18/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 1253	01/07/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
SSA-1372-FC (Foreign Claims)--Individuals/Households	SSA-1372-BK-FC	Student's Statement Regarding School Attendance
SSA-1372-BK-FC (Foreign Claims)--State/Local/Tribal Government	SSA-1372-BK-FC	Student's Statement Regarding School Attendance
SSA-1372-BK (Domestic)--Individuals/Households	SSA-1372-BK	Advanced Notice of Termination of Child's Benefits
SSA-1372-BK (Domestic)--State/Local/Tribal Government	SSA-1372-BK	Advanced Notice of Termination of Child's Benefits

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ICR Summary of Burden

	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	200,000	200,000	0	0	0	0
Annual Time Burden (Hours)	36,666	33,333	0	3,333	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in the public reporting burden from 33,333 to 36,666 is due to an increase in the average burden per response by one minute. SSA is now asking the respondents to annotate the student’s expected graduation date to the page of the form that the school official keeps for future reporting purposes. SSA estimates that it may take up to one minute for the school official to complete that extra step. Also, the other changes in the burden are due to conversion of this ICR to ROCIS. Prior to ROCIS we were unable to split this ICR into it's component ICs. Through ROCIS we have created four ICs in order to show both the burden per respondent type and per form.

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Annual Cost to Federal Government: $1,232,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/06/2008

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