This form is used by SSA to collect
information to determine whether an individual, whose disability or
blindness has ceased, is eligible for continued benefit payments
because of participation in an approved program of vocational
rehabilitation services, employment services or other support
services. The respondents are State vocational rehabilitation
agencies, other public or private providers of vocational
rehabilitation services and employment services or other support
services.
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:
(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;
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.