Information Collection

1. State Agency Ticket Assignment Form. 2. State Vocational Rehabilitation Ticket to Work Information Sheet and 3. Individual Work Plans (IWP) Information Sheet

IC 9671 under ICR 200204-0960-001 · OMB 0960-0641.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0641 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	1. State Agency Ticket Assignment Form. 2. State Vocational Rehabilitation Ticket to Work Information Sheet and 3. Individual Work Plans (IWP) Information Sheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	SSA-1365	No	No
Form	SSA-1366	No	No
Form	SSA-1367	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31,492	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	31,492	31,492
Annual IC Time Burden (Hours)	5,915	5,915
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.