View Information Collection Request (ICR) Package
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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:
0960-0629
ICR Reference No:
201908-0960-001
Status:
Historical Active
Previous ICR Reference No:
201604-0960-004
Agency/Subagency:
SSA
Agency Tracking No:
Title:
Work Incentives Planning and Assistance (WIPA)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
05/18/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/10/2019
Terms of Clearance:
Agency updated their supporting statement and ICs.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2023
36 Months From Approved
05/31/2020
Responses
90,000
0
90,000
Time Burden (Hours)
25,000
0
25,000
Cost Burden (Dollars)
0
0
0
Abstract:
As part of SSA’s strategy to assist SSDI) beneficiaries and SSI recipients who wish to return to work and achieve self-sufficiency, SSA established the Work Incentives Planning and Assistance (WIPA) program. This community based, work incentive, planning and assistance project collects identifying claimant information via project sites and community work incentives coordinators (CWIC). SSA uses this information to ensure proper management of the project, with particular emphasis on administration, budgeting, and training. In addition, project sites and CWIC’s collect data from SSDI beneficiaries and SSI recipients on background employment, training, benefits, and work incentives. SSA is interested in identifying SSDI beneficiary and SSI recipient outcomes under the WIPA program, to determine the extent to which beneficiaries with disabilities and SSI recipients achieve their employment, financial, and healthcare goals. SSA will also use the data in its analysis and future planning for SSDI and SSI programs. Respondents are SSDI beneficiaries, SSI recipients, community project sites, and employment advisors.
Authorizing Statute(s):
US Code:
42 USC 1320b-20
Name of Law: Social Security Act
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:
84 FR 34469
07/18/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 53551
10/07/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served)
SSA-4566, SSA-4565
WIPA Intake Information
,
WIPA Case Notes
Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served)
SSA-4565, SSA-4566
WIPA Beneficiary/Recipient Application
,
WIPA CASE NOTES
Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries
SSA-4565
WIPA Intake Information
Work Incentives Planning and Assistance Program (WIPA)--Help Line
SSA-4567
Help Line WIPA Referral
Work Incentives Planning and Assistance Program (WIPA)--Medium Site (150-599 beneficiaries served)
SSA-4565 , SSA-4566
Wipa Intake Information
,
WIPA Case Notes
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
90,000
90,000
0
0
0
0
Annual Time Burden (Hours)
25,000
25,000
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
There are no changes to the public reporting burden; however, due to changes in our internal accounting process, we are changing the way we report the information. Previously, we reported all project sites under one information collection (IC); but now, for better accounting, we are reporting them by size of the site. While this does not actually cause a burden change, it makes it easier for SSA to track the number of respondents per cite. In addition, we are replacing electronic versions of WIPA with paper Forms SSA-4565 (WIPA Intake Information); SSA-4566 (WIPA Case Note); and SSA-4567 (Help Line WIPA Referral) to collect the information we were collecting through the electronic version. Since it takes the same amount of time for respondents to use the electronic versions as it does the paper versions, there are no changes to the public reporting burden for this change.
Annual Cost to Federal Government:
$23,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Faye Lipsky 410 965-8783 faye.lipsky@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:
10/10/2019
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