Time Report of Personnel Services for Disability Determination Services--SSA-4514

Instructions for Completion of Form SSA-4514
Heading

Line Entries

Enter official name of agency, State, and the last
day of the quarter for which you are reporting
(e.g., March 31, YYYY, June 30, YYYY, etc.)

Line 1. Total Full-Time Personnel - Calculation
(sum of 1a through 1I).

Note: Do g& include non-Federal hours,
compensatory time worked or compensatory
leave used within any category of this report.

Lines 1 (a thru 1) - Complete columns
A, B, and D for each full-time position
listed.
Line 2. Total Part-Time Personnel - Calculation
(sum of 2a through 21).

Column Entries

Column A, On Duty Hours (excluding OT) This column should reflect hours worked during
the report period by all personnel engaged in the
SSA disability program. Do &include hours
for overtime, holidays observed by the State
agency, sick, annual, or other paid or unpaid
leave.
Column B, Holiday and Leave Hours - This
column should reflect hours for holidays
observed by the State agency, sick, annual, or
other paid leave. The entries should include the
proportionate share of the agency who worked
part-time on the SSA disability program.
Column C. Total Hours (excluding OT) Calculation (sum of columns A and B).
Column D. overtimi Hours - This column
should reflect overtime hours worked during the
report period by all personnel engaged in the
SSA disability program.
Column E. Total Hours - Calculation (sum of
columns C and D).
Column F. Total FTEs - Calculation (sum of
column C divided by 520 hours-plus--column
D divided by 438.75 hours).

Lines 2 (a thru 1) - Complete columns
A, B, and D for each part-time position
listed.
Line 3. Total Temooraw Personnel - Calculation
(sum of 3a and 3b).
Lines 3 (a and b) - Enter total hours
charged to temporary personnel (fulltime and part-time) working on the SSA
disability program as appropriate for
columns A, B, and D. This category
should reflect DDS personnel hired into
temporary positions. Do not include
acquisition of contract services (e.g.,
Kelly Services, etc.).
Line 4, Total Direct Personnel Services Calculation (sum of lines 1.2, and 3).
Line 5, Total FTE (calculation] - Calculation
(divides the sum of columns A and C by 520
hours to compute regular FTE time and column
D by 438.75 to compute FTE overtime).
Remarks - Explain any unusual situations (e.g.,
non-federal time, leave without pay, extended
sick leave, military leave, hours spent attending
conferences, etc.) or any other comments
necessary to clarify the report.
Si~nature/Title/Date- Self-explanatory

Paperwork Reduction Act Statements

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This information collection.meets the clearance requirements of U.S.C. 9 3507, as ended by section 2 of the
Pa envork Reduction t of 1995.
are no equired to
er these questi
unless we di
y a valid Office
instructions, ga er the necess ry facts,
answer the questions.
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Thefollowing revised PRA Statement will be inserted into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. 5 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 90
minutes to read the instructions, gather the facts, and answer the questions. You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD
21235-6401. Send & comments relating to our time estimate to this address, not the
completed form.