Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served) New 17700 5900 0 Form SSA-4565 WIPA Intake Information
Form SSA-4566 WIPA Case Notes
Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served) Modified 4800 1600 0 Form SSA-4565 WIPA Beneficiary/Recipient Application
Form SSA-4566 WIPA CASE NOTES
Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries New 30000 12500 0 Form SSA-4565 WIPA Intake Information
Work Incentives Planning and Assistance Program (WIPA)--Help Line Modified 30000 2500 0 Form SSA-4567 Help Line WIPA Referral
Work Incentives Planning and Assistance Program (WIPA)--Medium Site (150-599 beneficiaries served) Modified 7500 2500 0 Form SSA-4565 Wipa Intake Information
Form SSA-4566 WIPA Case Notes
Total burden requested under this ICR: 90000 25000 0  
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