SSA-1372-BK-FC (Foreign Claims)--Current Version

Form Approved
OMB No. 0960-0105

SOCIAL SECURITY ADMINISTRATION

ADVANCE NOTICE OF TERMINATION OF CHILD'S BENEFITS
NAME AND ADDRESS

SOCIAL SECURITY CLAIM NUMBER

NAME OF CHILD BENEFICIARY TO WHOM THIS NOTICE APPLIES

DATE STUDENT BECOMES AGE 18

YOUR BENEFITS WILL AUTOMATICALLY STOP AT AGE 18 UNLESS:
•
•

You are a full-time student at an elementary or secondary-level school
(as defined by the jurisdiction in which the school is located), or
You qualify for childhood disability benefits.

Your benefits will end with the payment for the month before the month in which you attain age 18. You
become age 18 on the day before your 18th birthday. This is important when your birthday is on the first day
of the month. For example, if your 18th birthday is June 1, you become age 18 on May 31. If you are neither a
full-time student nor disabled in May, benefits would not be payable for May. The last benefit payment to
which you would be entitled would be the one received in May, which represents your payment for April.

FOR YOU TO RECEIVE STUDENT BENEFITS AFTER AGE 18, YOU MUST:
1.
2.
3.
4.

Complete the form, STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE (pages 2 and 3).
Take the form to the school for a school official to certify the information you provide.
Leave the form, NOTICE OF CESSATION OF FULL-TIME SCHOOL ATTENDANCE (page 4), with the
school official.
Take or mail the completed form, STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE
OUTSIDE THE UNITED STATES, to one of the following offices.

• If you live in Canada, Samoa or the British Virgin Islands, the nearest U.S. Social Security Office;
• If you live in the Philippines, the SSA Division of the Veterans Affairs Regional Office, 1131 Roxas
•

Blvd, 0930 Manila;
If you live in any other country, the Social Security Administration, Office of International Operations,
P.O. Box 17775, Baltimore, MD 2123-7775 or call the nearest U.S. Embassy or consulate to
determine which U.S. Foreign Service post handles Social Security matters.

TO RECEIVE CHILDHOOD DISABILITY BENEFITS, YOU MUST CONTACT ONE OF THE OFFICES SHOWN
ABOVE AND HAVE THE FOLLOWING INFORMATION:
1.
2.

A history of the disabling condition, including names and addresses of medical record sources (such as
doctors and hospitals) and schools attended. If you have worked, you must also furnish work history.
Your U.S. Social Security Number.

Please keep the attached sheet, INFORMATION ABOUT BENEFITS PAST AGE 18 (page 6), for your records. It
contains important information about eligibility for student benefits and reporting responsibilities.
Form SSA-1372-BK-FC (3-2001) EF (10-2001)
Destroy SSA-1372-F4 -FC after 8/31/2001

Page 1

Form Approved
OMB No. 0960-0105

SOCIAL SECURITY ADMINISTRATION

STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE OUTSIDE THE UNITED STATES
The information requested on this form is sought pursuant to
authority granted by law (42 U.S.C.402 and 405). While you are
not required to respond, your cooperation is needed to confirm
your past and/or continuing entitlement to student benefits.

NAME AND ADDRESS

SOCIAL SECURITY CLAIM NUMBER

(To change or correct the address, line through the old address
and insert the new address.)

1.

CURRENT SCHOOL YEAR
(a). Are you now in full-time attendance?

Yes

No

(b). Print the following information about the school you attend.
NAME

School Year Began
(Month, Day, Year)

School Year Will End
(Month, Day, Year)

STREET ADDRESS
CITY AND STATE OR PROVINCE
(c). Show the type of school:
High School (including "gymnasium,"
"lycee," "secundaria," or other
secondary level school)

Preparatoria
Other (Specify)

(d). Show the number of hours you are scheduled
to attend each week.
2.

3.

(e). Show the grade in which you are enrolled.

Last School Year
(a). Print name and address of the school you attended in the last school year. (If it is the same as the
school shown in
question 1, show "Same" and go to (b).)

(b). Date the school year began (Month, Day, Year)

Date the school year ended (Month, Day, Year)

(c). Show the number of hours you were scheduled
to attend each week.

(d). Show the grade in which you were enrolled.

Next School Year
(a). Do you intend to be in full-time attendance at a school in the next school year?
Yes
No
Undecided
(If "No" or "Undecided," go to question 4. If "Yes,", go to "(b)" below.)
(b). Print name and address of the school you will attend. (If it is the same as the school shown in
question 1, show "Same" and go to (c).)

(c). Date the school year will begin (Month, Day, Year) Date the school year will end (Month, Day, Year)
(d). Show the number of hours you will be scheduled
to attend each week.
Form SSA-1372-BK-FC (3-2001) EF (10-2001)

Page 2

(e). Show the grade in which you will be enrolled.

4. Are you disabled?

Yes

No

5. Are you married?

Yes

No

If "Yes," show the date you were married.
6. (a). Have you worked in employment or self-employment outside
the United States during any of the past 13 months,
including the present month? (See the information on page 6.)

Yes

No

(b). If "Yes," give the following information about your apprenticeship, employment or selfemployment outside the United States.
Name and Address of Employer
(If self-employed, show "self" and
address at which the trade or
business was conducted.)

Type of
Business

Date Employment
(or selfemployment)
Began

(c). Will you work in employment or self-employment
in the next school year?

Date Employment
(or self-employment)
Ended
(If not ended, leave blank.)

Yes

No

7. If you are, or will be, paid by your employer to attend school, give your employer's name and address.
(If it is the same as in question 6, write "same as above.")

I agree to promptly notify the Social Security Administration if I marry, go to work, or if there is any
change in my school attendance. I agree to return any benefit payment to which I am not entitled. I know
that anyone who makes or causes to make a false statement or representation of material fact for use in
determining a right to payment under the Social Security Act commits a crime punishable under Federal law
by fine, imprisonment or both. I affirm that all the information I have given in this document is true. I also
certify that I have read the detached information sheet. I authorize my school to disclose to the Social
Security Administration any information concerning my status as a student as it pertains to past, current or
future Social Security student benefits.
First Name, Middle Initial, Last Name (Write in ink)

SIGNATURE OF STUDENT
Mailing Address

SIGN
HERE
Student's Own Social Security Number

Telephone No. (Area Code)

Date

CERTIFICATION BY SCHOOL OFFICIAL: (I know that anyone who makes or causes to be made a
false statement or representation of material facts in an application for use in determining a right to
payment under the Social Security Act commits a crime punishable under Federal law and/or State law. I
affirm that all information I have given in this document is true.)
1. All information entered in items 1, 2 and 3 is correct
according to this school's records.

Yes

No

Yes

No

2. Is the school's course of study of at least 13 weeks
duration?
SCHOOL
OFFICIAL
SIGNS

School Official's Signature

Form SSA-1372-BK-FC (3-2001) EF (10-2001)

Title

Telephone No. (Area Code)

Page 3

Date

SCHOOL SHOULD DETACH AND RETAIN THIS FORM

Form Approved
OMB No. 0960-0105

SOCIAL SECURITY ADMINISTRATION

NOTICE OF CESSATION
OF FULL-TIME SCHOOL ATTENDANCE
NAME OF SOCIAL SECURITY BENEFICIARY

DATE OF BIRTH

INDIVIDUAL IDENTIFIED ABOVE
CEASED TO BE A FULL-TIME
STUDENT AT THIS SCHOOL ON

REASON:

(Month, Day, Year)
NAME AND ADDRESS OF SCHOOL

SOCIAL SECURITY CLAIM NUMBER

1. Withdrawal, suspension or expulsion
2. Changed to PART-TIME status
3. Failed to continue in full-time attendance at start
of new term (or new school year)
4. Other (Explain)

SIGNATURE (or facsimile) OF SCHOOL OFFICIAL
DATE

TITLE

IMPORTANT INFORMATION ABOUT THIS FORM
One of the conditions a child between 18 and 19 must meet to receive Social Security benefits is that
he/she be a full-time student. For Social Security purposes, a student in "full-time attendance" is one
who is attending an elementary or secondary-level school, and is enrolled in a day or evening
non-correspondence course of at least 13 weeks duration. The attendance must be at grade/year 12 or
lower. In addition, the student must be scheduled to attend at the rate of at least 20 hours weekly, and
be carrying a subject load which is considered full-time for day students under the school's standards
and practices. This form contains the name, date of birth, and Social Security claim number of a child
beneficiary who tells us that he/she is (or will be when school resumes) a full-time student at your
school.
Please hold this form until the student is no longer a full-time student at your school (whether this is
during the current school year, or any time after that). Then, enter the date he/she stopped being a
full-time student, check the appropriate box above and return the completed form to the Social Security
office shown above, the nearest U.S. Social Security office or the nearest U.S. Embassy or consulate.
In the Philippines, return it to the SSA Division, U.S. Veterans Affairs Regional Office, 1131 Roxas
Blvd., 0930 Manila.
You should not return the form to report that attendance stopped for a scheduled break (e.g., summer
break) unless the student is not expected to return from the break. You also should not complete the
form for a student who completes on school year as a full-time student unless he/she will not return to
full-time attendance at the beginning of the next school year.
If there is any question as to whether a student's attendance is full or part-time, please apply the usual
criteria followed by your school.
The people in the above offices will be glad to help you with any questions concerning these forms or
any other questions you have about Social Security.
Thank you for your cooperation.

Form SSA-1372-BK-FC (3-2001) EF (10-2001)

Page 4

PRIVACY ACT/PAPERWORK REDUCTION ACT NOTICE

The Social Security Administration is authorized to collect information about school attendance
under sections 202(d) and 205(a) of the Social Security Act, as amended (42 U.S.C. 402 and
405). While completing this form is voluntary, failure to provide all or part of this information is
cause for suspension of benefit payments. The information on this form may be disclosed by the
Social Security Administration to another person or agency for the following purposes: (1) to
assist the Social Security Administration in establishing the student's right to Social Security
benefits, (2) to help with statistical research and audits necessary to assure the integrity and
improvement of the Social Security programs, and (3) to comply with laws requiring or allowing
the exchange of information between the Social Security Administration and another agency.
This information will be used to verify full-time attendance in school, and to determine
continuing eligibility to student benefits.
We may also use the information you give us when we match records by computer. Matching
programs compare our records with those of other Federal, State, or local government agencies.
Many agencies may use matching programs to find or prove that a person qualifies for benefits
paid by the Federal government. The law allows us to do this even if you do not agree to it.
Explanations about these and other reasons why information you give us may be used or given
out are available in Social Security offices. If you want to learn more about this, contact any
Social Security office.

PAPERWORK REDUCTION ACT STATEMENT
PAPERWORK REDUCTION ACT: This information collection meets the clearance requirements
of 44 U.S.C. §3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You
are not required to answer these questions unless we display a valid Office of Management and
Budget control number. We estimate that it will take you about 2 minutes to read the
instructions, gather the necessary facts, and answer the questions.

Form SSA-1372-BK-FC (3-2001) EF (10-2001)

Page 5

STUDENT SHOULD DETACH AND KEEP THIS INFORMATION FOR FUTURE REFERENCE

INFORMATION ABOUT BENEFITS PAST AGE 18
If you quality for Social Security benefits because you are a full-time student, you can start receiving
benefits as early as age 18 and usually through the month you graduate from the 12th grade, or the
month before age 19, whichever is earlier. Your benefits will be paid in your own name beginning at
age 18, either by direct deposit or by mail. Generally, we consider you to be a full-time student if you
are in full-time attendance at a school that provides education at the secondary (grade 12) level or
below. Full-time attendance means you are scheduled to attend classes at the rate of 20 hours each
week, or at the rate determined by your school to be full-time.

INFORMATION ABOUT BENEFITS PAST AGE 19
Your benefits may continue past age 19 if you are in actual full-time attendance at a school that provides
elementary or secondary education in the month you become age 19. If the school operates on a yearly basis,
then payment may be continued after age 19 up through the earlier of (1) the month you complete the course
in which you are enrolled full-time or (2) the second month after the month you become age 19. If the school
requires re-enrollment on other than a yearly basis, benefits may continue through the month ending the term
that is in progress when you become age 19. If you believe this situation applies to you, contact one of the
offices listed on page 1 under item 4. Note that payments beyond age 19 cannot be made if you become age

IMPORTANT RESPONSIBILITIES
YOU MUST NOTIFY THE SOCIAL SECURITY ADMINISTRATION PROMPTLY IF:
•
•
•
•
•

YOU MARRY
YOU STOP ATTENDING SCHOOL
YOU REDUCE YOUR SCHOOL ATTENDANCE BELOW FULL-TIME
YOU CHANGE SCHOOLS
YOU ARE PAID BY YOUR EMPLOYER TO ATTEND SCHOOL (at the request of or as a requirement
of your employer)

Your benefits may end if any of the above occur. You must report each of these events even if
you believe your benefit should not end. We will tell you about how your benefits may be affected.
YOU SHOULD ALSO NOTIFY THE SOCIAL SECURITY ADMINISTRATION PROMPTLY IF:
• YOU MOVE OR CHANGE YOUR MAILING ADDRESS
• YOU WORK IN EMPLOYMENT OR SELF-EMPLOYMENT

When you are awarded Social Security benefits as a student, you will receive a booklet that
further covers your responsibilities. It is important for you to read that booklet.

HOW WORK OUTSIDE THE UNITED STATES AFFECTS YOUR BENEFITS
If your earnings are not subject to U.S. Social Security taxes, a 45-hour test applies. Under this test, if you are
employed (or self-employed) on more than 45 hours in a month, you are not eligible to receive a benefit for that
month. How much you earn and how many days you work in a month does not matter. A person is employed
if he/she performs services for someone else and receives cash payment or other compensation for these
services. This includes part-time work, and work as an apprentice.
Failure to report employment in the United States or outside the United States can result in the loss of
additional benefits.
Form SSA-1372-BK-FC (3-2001) EF (10-2001)

Page 6

PRIVACY ACT/PAPERWORK REDUCTION ACT NOTICE

The Social Security Administration is authorized to collect information about your school
attendance under sections 202(d) and 205(a) of the Social Security Act, as amended (42 U.S.C.
402 and 405). While completing this form is voluntary, failure to provide all or part of this
information is cause for suspension of benefit payments. The information on this form may be
disclosed by the Social Security Administration to another person or agency for the following
purposes: (1) to assist the Social Security Administration in establishing your right to Social
Security benefits, (2) to help with statistical research and audits necessary to assure the
integrity and improvement of the Social Security programs, and (3) to comply with laws
requiring or allowing the exchange of information between the Social Security Administration
and another agency. This information will be used to verify full-time attendance in school, and
to determine continuing eligibility to student benefits.
We may also use the information you give us when we match records by computer. Matching
programs compare our records with those of other Federal, State, or local government agencies.
Many agencies may use matching programs to find or prove that a person qualifies for benefits
paid by the Federal government. The law allows us to do this even if you do not agree to it.
Explanations about these and other reasons why information you give us may be used or given
out are available in Social Security offices. If you want to learn more about this, contact any
Social Security office.

PAPERWORK REDUCTION ACT STATEMENT
PAPERWORK REDUCTION ACT: This information collection meets the clearance requirements
of 44 U.S.C. §3507, as amended by Section 2 of the Paperwork Reduction Act of 1995. You
are not required to answer these questions unless we display a valid Office of Management and
Budget control number. We estimate that it will take you about 8 minutes to read the
instructions, gather the necessary facts, and answer the questions.

Form SSA-1372-BK-FC (3-2001) EF (10-2001)

Page 7