Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
WIPA Case Notes (SSA-4566) Modified 320400 10680 0 Form SSA-4565 Wipa Case Notes
Form SSA-4565 Help Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake (SSA-4565)
WIPA STAR System New 1345680 448560 0 Other-WIPA Star Screens
Other-WIPA Star System Fields
Other-Master list of WIPA Star Screen Elements
Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served) Removed 0 0 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) Removed 0 0 0 Form SSA-4565 WIPA Beneficiary/Recipient Application
Form SSA-4566 WIPA CASE NOTES
Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565) Modified 32000 13333 0 Form SSA-4565 WIPA Intake Information
Form SSA-4566 WIPA CASE NOTES
Work Incentives Planning and Assistance Program (WIPA)--Help Line Removed 0 0 0 Form SSA-4567 Help Line WIPA Referral
Total burden requested under this ICR: 1698080 472573 0  
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