Work Reintegration Study

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
9456	Work Reintegration Study	Migrated

ICR Details

OMB Control No: 0960-0543	ICR Reference No: 199512-0960-005
Status: Historical Active	Previous ICR Reference No: 199411-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Work Reintegration Study
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: 03/15/1996
	Date Received in OIRA: 12/26/1995
Terms of Clearance: This information collection is approved through 1-97 under the following conditions: SSA will proceed with the State collections as described in the attached revised Part B. SSA should include a cover letter from the State to the individuals urging them to participate. If SSA does not obtain an 80% response rate, they may not use the data collected for any analytical purposes in the evaluation. If SSA does get at least 80%, the agency will proceed with plans to analyze the characteristics of the non- respondents with the respondents to identify potential bias in those indiduals agreeing to participate. OMB notes that the analysis of the State-administered programs is confined to New Jersey and California only, and is not generalizable. In the Report issued on the United States, SSA must explicitly note that the State findings are confined to those States examined.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1999	03/31/1999	03/31/1996
Responses	1,500	0	2,000
Time Burden (Hours)	1,500	0	2,000
Cost Burden (Dollars)	0	0	0

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Abstract: The information on the two forms used in this study will aid the Social Security Administration in determining what steps it can take to help beneficiaries who are disabled due to a back condition to return to work. The respondents are beneficiaries with a disabling back condition.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Work Reintegration Study

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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	1,500	2,000	0	-500	0	0
Annual Time Burden (Hours)	1,500	2,000	0	-500	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: Yes

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 12/26/1995

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