Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
20 CFR 411.200(b) WISE Webinar Registration Page Unchanged 24000 1200 0 Other-online registration form
State Agency Ticket Assignement Form SSA-1365 New 948 237 0
Ticket Portal New 3792 695 0
a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone Unchanged 6428 268 0
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal Modified 25713 536 0 Other-Internet Screens
Other-Internet Screens
Other-screens
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Modified 1956 1956 0 Form and Instruction SSA-1370
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Portal Screens Unchanged 5868 978 0 Other-screens
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Unchanged 40324 3360 0 Other-screens
a.) 20 CFR 411.140(d)(3) Virtual Job Fair Registration - Employment Networks Unchanged 500 83 0 Form and Instruction SSA-1370
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Unchanged 2494 624 0 Other-screens
Other-screens
b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens Unchanged 7481 1372 0 Other-screens
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 Unchanged 6 3 0
c) 20 CFR 411.200(b) - Request for Certification of Work Portal Screens Unchanged 64824 5402 0 Other-Internet Screens
Other-screens
c) 20 CFR 411.200(b) - SSA-1375 (and cover letters) Modified 112362 28091 0 Form SSA-1375
Instruction
Instruction
c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress Unchanged 41 21 0
c.) 20 CFR 411.200(b) Virtual Job Fair Registration - Individuals Unchanged 9000 1500 0 Form and Instruction SSA-1370
d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System Modified 6 1 0
e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement Unchanged 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) Modified 11220 0 0
f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al) Modified 42075 15427 0
f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1393; SSA-1399; SSA-1396; SSA-1398 Modified 2805 1870 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
Other-screens
g) 20 CFR 411.325(f) - Periodic Outcomes Reporting Unchanged 1371 1028 0
h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions Unchanged 2 4 0
i) 20 CFR 411.320 - EN Contract Changes, Portal Modified 158 13 0 Other-Internet Screens
i) 20 CFR 411.320 - SSA-1394, EN Contract Changes Modified 52 9 0 Form and Instruction SSA-1394
Total burden requested under this ICR: 372032 65428 0  
To view an IC, click on IC Title