Work Incentives Planning and Assistance (WIPA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
WIPA Beneficiary/Recipient Application	Form	Modified	Available
Work Incentives Planning and Assistance Community Work Incentives Coordinator (CWIC) Form	Form	New	Repair queued
Work Incentives Planning and Assistance formerly BPAO	Form	New	Available
Supporting Statement--0629[2].doc	Supporting Statement A	Uploaded 0000-00-00	Available
Addendum--0629.doc	Supplementary Document	Uploaded 2007-02-27	Available
BPAO Specialist Form.doc	Supplementary Document	Uploaded 2004-04-16	Available
BPAO Site Form.doc	Supplementary Document	Uploaded 2004-04-16	Available
BPAO Recipient Form.doc	Supplementary Document	Uploaded 2004-04-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9650	Work Incentives Planning and Assistance Program (WIPA)--Beneficiaries	Form	Modified	WIPA Beneficiary/Recipient Application
178887	Work Incentives Planning and Assistance Program (WIPA)--Businesses	Form	New	Work Incentives Planning and Assistance Community Work Incentives Coordinator (CWIC) Form
178887	Work Incentives Planning and Assistance Program (WIPA)--Businesses	Form	New	Work Incentives Planning and Assistance formerly BPAO

ICR Details

OMB Control No: 0960-0629	ICR Reference No: 200701-0960-012
Status: Historical Active	Previous ICR Reference No: 200403-0960-009
Agency/Subagency: SSA	Agency Tracking No:
Title: Work Incentives Planning and Assistance (WIPA)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/07/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/30/2007
Terms of Clearance: OMB approves this collection consistent with the revisions agreed to by SSA on 6/6/07. SSA will: (1) clarify the numbering for question 10 and (2) SSA will present the finished or near finished WIPA computer screens project to OMB upon expiration of the collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2010	36 Months From Approved	06/30/2007
Responses	60,569	0	60,569
Time Burden (Hours)	5,019	0	5,317
Cost Burden (Dollars)	0	0	0

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Abstract: Like the Benefits Planning Assistance Outreach (BPAO) program which it replaces, the Work Incentives Planning and Assistance (WIPA) program collects identifying information from the project sites and the community work incentives coordinators. In addition, data are collected from the beneficiaries on background employment, training, benefits and work incentives. SSA is interested in identifying beneficiary outcomes under the WIPA program to determine the extent to which beneficiaries with disabilities achieve their employment, financial and health care goals. The data will also be valuable to SSA in its analysis and future planning for Social Security Disability Insurance and Supplemental Security Income (SSI) programs.

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Authorizing Statute(s): US Code: 42 USC 1320b-20
  

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:
	72 FR 2081	01/17/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 13851	03/23/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Work Incentives Planning and Assistance Program (WIPA)--Beneficiaries	N/A	WIPA Beneficiary/Recipient Application
Work Incentives Planning and Assistance Program (WIPA)--Businesses	N/A , N/A	Work Incentives Planning and Assistance formerly BPAO ,   Work Incentives Planning and Assistance Community Work Incentives Coordinator (CWIC) Form

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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	60,569	60,569	0	0	0	0
Annual Time Burden (Hours)	5,019	5,317	0	0	-298	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: No

Burden Reduction Due to:

Short Statement: The public burden has decreased for the BPAO due to rounding the average burden per response estimates to better reflect the actual time it takes to answer the questions.

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Annual Cost to Federal Government: $69,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 03/30/2007

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