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Ssa-1372bkfc Advance Notice of Termination of Child's Benefits

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Form SSA-1372-BK-FC (01-2018)
Discontinue Prior Editions
Social Security Administration
ADVANCE NOTICE OF TERMINATION OF CHILD'S BENEFITS
Page 1 of 8
OMB No. 0960-0105
NAME AND ADDRESS SOCIAL SECURITY CLAIM NUMBER
NAME OF CHILD BENEFICIARY TO WHOM THIS
NOTICE APPLIES
DATE CHILD 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 become 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. Complete the form, STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE OUTSIDE THE UNITED
STATES (pages 2 and 3).
2. Take the form to the school for a school official to certify on page 4 the information you provide on pages 2
and 3.
3. Leave the form, NOTICE OF CESSATION OF FULL-TIME SCHOOL ATTENDANCE (pages 5 and 6), with the
school official.
4. Take or mail the completed pages 2, 3, and 4 of this form 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 any other country, the Social Security Administration, Division of International
Operations, P.O. Box 17769, Baltimore, MD 21235-7769 or your Federal Benefits Unit. For a list of
Federal Benefits Units, visit
www.socialsecurity.gov/foreign/foreign.htm.
TO RECEIVE CHILDHOOD DISABILITY BENEFITS, YOU MUST CONTACT ONE OF THE OFFICES SHOWN ABOVE
AND HAVE THE FOLLOWING INFORMATION:
1. 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 your work history.
2. Your U.S. Social Security Number.
Please keep the attached sheet, INFORMATION ABOUT BENEFITS PAST AGE 18 (page 7), for your records. It
contains important information about eligibility for student benefits and reporting responsibilities.
Form SSA-1372-BK-FC (01-2018)
Social Security Administration
Page 2 of 8
OMB No. 0960-0105
STUDENT'S STATEMENT REGARDING SCHOOL ATTENDANCE
OUTSIDE THE UNITED STATES
The information requested on this form is sought pursuant
to the 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
(To change or correct the address, line through the old
address and insert the new address.)
SOCIAL SECURITY CLAIM NUMBER
1. Current School Year
(a). Are you now in full-time attendance? Yes No
(Note: If you are completing this form during a summer break period and you were in full-time attendance prior to
the break and will continue school in the fall, you should answer YES to question 1(a). You should show the
beginning date of the fall semester/term for question 1(b). See question 2 for past school attendance information.)
(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).
Preparatory School (including "preparatoria").
Other (Specify)
(d). Show the number of hours you are scheduled to attend
each week.
(e). Show the grade in which you are enrolled.
(f). Show your EXPECTED graduation date from SECONDARY school, (e.g. high school).
Month, Year
(g). What months between now and your expected graduation will you not be in full-time attendance for the full month?
(For example months of summer vacation).
2. Last School Year
(a). Print the 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.
3. 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) .)
Form SSA-1372-BK-FC (01-2018) Page 3 of 8
(b). Print the 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.
(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 7.)
Yes No
(b). If "Yes," give the following information about your apprenticeship, employment or self- employment 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 self- employment) Began.
Date Employment (or self-employment) Ended. (If not ended, leave blank.)
(c). Will you work in employment or self-employment in the next school year? 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.")
8. Do you have an unsatisfied warrant, over 30 days old, issued for your arrest
because you were charged with a crime that carries a penalty of death or
confinement of over one year, or because you violated a condition of Federal
or State probation or parole?
Yes No
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 of the information that 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.
SIGNATURE OF STUDENT
First Name, Middle Initial, Last Name (Write in ink)
Mailing Address
Student's Own U.S. Social Security Number
Telephone No. Date
CERTIFICATION BY SCHOOL OFFICIAL
NAME OF STUDENT SOCIAL SECURITY NUMBER
Please review the information on pages 2 and 3, answer the questions below, annotate the student's expected
graduation date on page 5 and sign the form in the space provided. You should give the originals of pages 2, 3,
and 4 to the student to return to the U.S. Social Security Administration and keep copies in the school's files as
a record of the student's attendance that you certified. Please retain page 5 for reporting if the student's full-time
attendance ends, or the student graduates before the date shown on page 2.
1. All information entered in items 1, 2 and 3 on pages 2 and 3 is correct
according to the school's records.
Yes No
2. Is the school's course of study of at least 13 weeks duration?
Yes No
3. Please indicate which of the following applies to the school's operating basis?
Yearly
Quarterly/Semester-No Reenrollment Required
Quarterly/Semester-Reenrollment Required
4. I received pages 5 and 6 of this form for reporting changes in the
student's attendance.
Yes No
5. I annotated page 5 of this form with the student's expected graduation
date as reported on page 2 of this form.
Yes No
I know that anyone who makes or causes to be made a false statement or representation of material fact in an
application or for use in determining a right to payment under the U.S. 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.
SCHOOL OFFICIAL SIGNS Title
Printed Name
Date Phone Number
Form SSA-1372-BK-FC (01-2018)
Social Security Administration
Page 4 of 8
OMB No. 0960-0105
SCHOOL SHOULD RETAIN THIS FORM
SOCIAL SECURITY ADMINISTRATION
Division of International Operations
P.O. Box 17769
Baltimore, MD 21235-7769 USA
NOTICE OF CESSATION OF FULL-TIME SCHOOL ATTENDANCE
NAME OF SOCIAL SECURITY BENEFICIARY DATE OF BIRTH SOCIAL SECURITY CLAIM NUMBER
Individual identified above ceased to be a full time student at this school on, (Month, Day, Year).
REASON:
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).
Name and address of school
I declare under penalty of perjury that I have examined all the information on this form and on any accompanying
statements or forms, and it is true and correct to the best of my knowledge.
Signature (or facsimile) of school official Printed Name
Title Date
IMPORTANT INFORMATION ABOUT THIS FORM
This form contains the name, date of birth and U.S. 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. 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.
Full-Time Attendance
For Social Security purposes, a student 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 in 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. If there is any question as to
whether the student's attendance is full or part-time, please apply your school's usual criteria.
What to Report
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, at the start of the next 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 or
your Federal Benefits Unit. For a list of Federal Benefits Units, visit www.socialsecurity.gov/foreign/foreign.htm
.
You should not return the form to report that attendance stopped for a scheduled break (e.g., summer break) unless you do
not expect the student to return after the break. You should report if the student stops attending school full-time, or
graduates, earlier than the date shown above.
The people in the above offices will be glad to help you with any questions concerning this form or any other questions you
have about Social Security.
Thank you for your cooperation.
Form SSA-1372-BK-FC (01-2018)
Social Security Administration
Page 5 of 8
OMB No. 0960-0105
Privacy Act Statement
Collection and Use of Personal Information
Form SSA-1372-BK-FC (01-2018)
Sections 202(d) and 205(a) of the Social Security Act, as amended, allow us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent
an accurate and timely decision on your claim.
We will use the information to verify your school attendance and eligibility for student benefits. We may also
share your information for the following purposes, called routine uses:
1. To applicants, claimants, prospective applicants or claimants, other than the data subject, their
authorized representative payees to the extent necessary to pursue Social Security claims and to
representative payees when the information pertains to individuals for whom they serve as
representative payees, for the purpose of assisting SSA in administering its representative payment
responsibilities under the Social Security Act and assisting the representative payees in performing
their duties as payees, including receiving and accounting for benefits for individuals for whom they
serve as payees; and
2. To the Department of State and its agents for administering the Social Security Act in foreign
countries through facilities and services of that agency.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For
example, where authorized, we may use and disclose this information in computer matching programs, in which
our records are compared with other records to establish or verify a person's eligibility for Federal benefit
programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0089,
entitled Claims Folders System. Additional information and a full listing of all our SORNs are available on our
website at www.socialsecurity.gov/foia/bluebook.
Paperwork Reduction Act
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the
Paperwork Reduction Act of 1995 . You do not need to answer these questions unless we display a valid Office
of Management and Budget (OMB) control number. We estimate that it will take about 3 minutes to read the
instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate
to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
Page 6 of 8
STUDENT SHOULD KEEP THIS INFORMATION FOR FUTURE REFERENCE
INFORMATION ABOUT BENEFITS PAST AGE 18
If you qualify 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 you
become 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 (if higher).
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. Note that payments beyond age 19 cannot be made if you become
age 19 in a month of nonattendance (for example, you become age 19 in a month when you are on summer
vacation).
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
•
YOUR EMPLOYER PAYS YOU TO ATTEND SCHOOL (either at his request or as a
requirement of employment)
•
AN UNSATISFIED WARRANT, OVER 30 DAYS OLD, WAS ISSUED FOR YOUR ARREST
BECAUSE YOU WERE CHARGED WITH A CRIME THAT CARRIES A PENALTY OF DEATH OR
CONFINEMENT OVER ONE YEAR, OR BECAUSE YOU VIOLATED A CONDITION OF FEDERAL
OR STATE PROBATION OR PAROLE.
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 MUST 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) for 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 (01-2018) Page 7 of 8
Form SSA-1372-BK-FC (01-2018) Page 8 of 8
Privacy Act Statement
Collection and Use of Personal Information
Sections 202(d) and 205(a) of the Social Security Act, as amended, allow us to collect this information.
Furnishing us this information is voluntary. However, failing to provide all or part of the information may prevent
an accurate and timely decision on your claim.
We will use the information to verify your school attendance and eligibility for student benefits. We may also
share your information for the following purposes, called routine uses:
1. To applicants, claimants, prospective applicants or claimants, other than the data subject, their
authorized representative payees to the extent necessary to pursue Social Security claims and to
representative payees when the information pertains to individuals for whom they serve as
representative payees, for the purpose of assisting SSA in administering its representative payment
responsibilities under the Social Security Act and assisting the representative payees in performing
their duties as payees, including receiving and accounting for benefits for individuals for whom they
serve as payees; and
2. To the Department of State and its agents for administering the Social Security Act in foreign
countries through facilities and services of that agency.
In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For
example, where authorized, we may use and disclose this information in computer matching programs, in which
our records are compared with other records to establish or verify a person's eligibility for Federal benefit
programs and for repayment of incorrect or delinquent debts under these programs.
A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0089,
entitled Claims Folders System. Additional information and a full listing of all our SORNs are available on our
website at www.socialsecurity.gov/foia/bluebook.
Paperwork Reduction Act
This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the
Paperwork Reduction Act of 1995 . You do not need to answer these questions unless we display a valid Office
of Management and Budget (OMB) control number. We estimate that it will take about 8 minutes to read the
instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate
to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401.
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Ssa-1372bkfc Advance Notice of Termination of Child's Benefits

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Completed 17 November 2019

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