The claimant is not performing substantial gainful activity (SGA) and the medical condition prevents performing SGA.
Provisional benefits: A claimant may be able to receive provisional (temporary) benefits while the request for reinstatement is being decided.
For persons with extended Medicare coverage: Part A hospital insurance and Part B medical insurance could terminate if the request for reinstatement is denied.
Witnesses: Witnesses are required only if this request has been signed by mark (x).
| Question | Answer |
|---|---|
| Form Name | Form SSA-371 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 26 |
| Avg. time to fill out | 5 min |
| Edition | 07-2024 |
| Issuing agency | Social Security Administration |
| Who signs | The claimant |
| Other names | SSA-371, SSA371, SSA 371, Form SSA-371, SSA-371 Request for Reinstatement, Request for Reinstatement Title II |
| Official source | Form SSA-371 (Rev 07-2024), Social Security Administration |
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