View Information Collection Request (ICR) Package
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View Information Collection (IC) List
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0960-0644
ICR Reference No:
200907-0960-009
Status:
Historical Active
Previous ICR Reference No:
200804-0960-005
Agency/Subagency:
SSA
Agency Tracking No:
Title:
The Ticket to Work and Self-Sufficiency Program, 20 CFR 411
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/20/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/21/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2013
36 Months From Approved
04/30/2010
Responses
206,926
0
121,981
Time Burden (Hours)
63,502
0
46,553
Cost Burden (Dollars)
0
0
0
Abstract:
Through its Ticket to Work Program Manager, SSA uses the information collected to operate and manage the Ticket to Work Program. SSA uses the Ticket to Work Program to assign Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) beneficiaries to a service provider, and follows their progress through the various stages of ticket program participation such as progress reviews or changes in ticket status. Most of the collections in this request require service providers to provide information to SSA for such tasks as selecting a payment system or requesting payments for helping the beneficiary achieve certain work goals. Most of the categories of information collected in this request are required for SSA to be in compliance with the Ticket to Work legislation and provide proper oversight of the program. The respondents are SSDI beneficiaries and blind or disabled SSI beneficiaries and their employment networks or State vocational rehabilitation agencies under the Ticket to Work Program.
Authorizing Statute(s):
US Code:
42 USC 405
US Code:
42 USC 1320b19
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
74 FR 45508
09/02/2009
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 67945
12/21/2009
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
16
IC Title
Form No.
Form Name
20 CFR 411.200(b)--SSA-1375 Internet Version (State ENs)
N/A, SSA-1375
Ticket to Work Progress Review Form
,
Electronic Data Exchange Response for Progress Reports (Draft Version)
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370
SSA-1370
Ticket to Work Individual Work Plan
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing
a) 411.140(d)(3); 411.325(a); 411.150(b)(3) - SSA-1365
SSA-1365
State Agency Ticket Assignment Form Ticket to Work and Self-Sufficiency Program
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments
b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures
c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status
c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374; SSA-L1377
SSA-1375
Ticket to Work Progress Review Form
c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress
d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System
e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement
f) 20 CFR 411.560, SSA-1401 - Split Payment Situations
SSA-1401
Employment Network Split Payment Request Form
f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1393; SSA-1399; SSA-1396; SSA-1398
SSA-1393, SSA-1391, SSA-1389, SSA-1399, SSA-1396, SSA-1398
Employment Network Payment Request Form
,
EN Services Certification Statement (For Use with Phase 1 Milestone 4 Request)
,
Employment Network Supplemental Earnings Statement
,
Auto Pay Request Form
,
Earnings Inquiry Request Form
,
Self-Employment Income (SEI) Form Beneficiary Quarterly Report Self-Employment
f) 20 CFR 411.575; SSA-1392 - EN Payment Status Report Request
SSA-1392
Employment Network Payment Status Report Request Form
g) 20 CFR 411.325(f) - Periodic Outcomes Reporting
h) 20 CFR 411.435, 411.615, 411.625 -- Dispute Resolutions
i) 20 CFR 411.320; SSA-1394 - EN Contract Changes
SSA-1394
Employment Network Contract Change Form
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
206,926
121,981
0
100,402
-15,457
0
Annual Time Burden (Hours)
63,502
46,553
0
20,440
-3,491
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The annual reporting burden for these information collections has increased due to the addition of new forms SSA-1391, SSA-1394, and SSA-1401; the new letter SSA-L1375; as well as the combination of two ICs (due to lack of funding, SSA did not create an Internet versions of the SSA-1375 as mentioned in the previous ICR. Rather we allow ENs to submit the form either via fax or email). We are also adjusting the burden for both the SSA-1365 and SSA 1370, which increases the public reporting burden.
Annual Cost to Federal Government:
$7,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Elizabeth Davidson 411-965-0454 liz.davidson@ssa.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
12/21/2009
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