Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone New 12856 536 0
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal New 16071 335 0 Other-Internet Screens
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Regular Telephone New 3214 268 0
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 Portal Screens New 2370 434 0 Other-Internet Screens
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Modified 3913 3913 0 Form and Instruction SSA-1370
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Portal Screens New 3912 2934 0 Other-Internet Screens
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Modified 35584 2965 0
a) 411.140(d)(3); 411.325(a); 411.150(b)(3) - SSA-1365 Modified 2370 593 0 Form SSA-1365
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Modified 4988 1247 0
b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens New 4988 914 0
b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures Unchanged 8505 709 0
c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status Modified 6 3 0
c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374 Modified 112362 28091 0 Form SSA-1375
Instruction
Instruction
c) 20 CFR 411.200(b) - SSA-L1377 Portal Screens New 21608 3961 0 Other-Internet Screens
c) 20 CFR 411.200(b) - SSA-L1377 Request for Certification of Work New 43216 10804 0 Form and Instruction SSA-L1377
c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress Modified 41 21 0
d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System Modified 5 1 0
e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement Modified 1 8 0
f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Modified 100 33 0 Form SSA-1401
f) 20 CFR 411.575 - Automatic Payments (SSA-1391 et al) New 28050 0 0
f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al) New 14025 5143 0
f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1393; SSA-1399; SSA-1396; SSA-1398 Modified 14025 9350 0 Form and Instruction SSA-1391
Form and Instruction SSA-1389
Form and Instruction SSA-1393
Form and Instruction SSA-1399
Form and Instruction SSA-1396
Form and Instruction SSA-1398
f) 20 CFR 411.575; SSA-1392 - EN Payment Status Report Request Removed 0 0 0 Form and Instruction SSA-1392
g) 20 CFR 411.325(f) - Periodic Outcomes Reporting Modified 1371 1371 0
h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions Modified 2 4 0
i) 20 CFR 411.320 - SSA-1394, EN Contract Changes Modified 210 35 0 Form and Instruction SSA-1394
Total burden requested under this ICR: 333793 73673 0  
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