Information Collection

Quarterly Work Incentive Demonstration Program Report Win Demonstration Data Validation Employer/employee Quest. Win Demonstr. Data Validat. State/local Office Staff Quest.

IC 115796 under ICR 198703-0970-022 · OMB 0970-0018.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0018 can be found here:

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Information Collection (IC) Details

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IC Title:	QUARTERLY WORK INCENTIVE DEMONSTRATION PROGRAM REPORT WIN DEMONSTRATION DATA VALIDATION EMPLOYER/EMPLOYEE QUEST. WIN DEMONSTR. DATA VALIDAT. STATE/LOCAL OFFICE STAFF QUEST.	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4769				No	No
Form	(9-81)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 567	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	104	104
Annual IC Time Burden (Hours)	1,560	1,560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.