Social Security Administration Survey of Ticket To Work Beneficiaries

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment 3.doc	Supplementary Document	Uploaded 2006-10-24	Available
Attachment 2.doc	Supplementary Document	Uploaded 2006-10-24	Available
Attachment 1.doc	Supplementary Document	Uploaded 2006-10-24	Available
Responses to OMB Questions on Ticket to Work Survey 101006.doc	Supplementary Document	Uploaded 2006-10-24	Repair queued
Ticket to Work Survey Part B Supporting Statement.doc	Supporting Statement B	Uploaded 2006-08-18	Available
Ticket to Work Survey Part A supporting statement.doc	Supporting Statement A	Uploaded 2006-08-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
44826	SSA Survey of Ticket to Work Beneficiaries	Other-Survey	New

ICR Details

OMB Control No: 0960-0733	ICR Reference No: 200608-0960-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Social Security Administration Survey of Ticket To Work Beneficiaries
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/26/2006
	Date Received in OIRA: 08/21/2006
Terms of Clearance: SSA will report back to OMB on the final response rate and the results of the nonresponse bias analysis.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2009	18 Months From Approved
Responses	800	0	0
Time Burden (Hours)	200	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: SSA plans to survey two groups of Social Security beneficiaries who qualified for the Ticket to Work (TTW) program. One group will have chosen to enter the program, while the other group did not. The survey will gather information on the media and social interaction preferences of both groups, which it hopes to 1) compare and contrast and 2) eventually parlay into developing a better communications plan to convince more beneficiaries to join the program. The respondents are beneficiaries who qualified for the TTW program.

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Authorizing Statute(s): PL: Pub.L. 106 - 170 sections 1 & 2 Name of Law: Ticket to Work and Work Incentives Improvement Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 28740	05/17/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 45090	08/08/2006
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
SSA Survey of Ticket to Work Beneficiaries

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ICR Summary of Burden

table that charts list 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	800	0	0	800	0	0
Annual Time Burden (Hours)	200	0	0	200	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection which increases the public burden due to the fact that SSA wants to evaluate the Ticket to Work program.

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Annual Cost to Federal Government: $62,831

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: 08/21/2006

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