Development of Participation in a Vocational Rehabilitation or Similar Program

Forms and Documents

Document	Type	Status	Availability
Form SSA-4290 Development of Participation in a Vocational Rehabilitation or Similar Program	Form	Modified	Repair queued
0960-0282 (SSA-4290) supporting statement(1).doc	Supporting Statement A	Uploaded 2008-02-04	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
9186	Development of Participation in a Vocational Rehabilitation or Similar Program	Form	Modified

ICR Details

OMB Control No: 0960-0282	ICR Reference No: 200801-0960-003
Status: Historical Active	Previous ICR Reference No: 200412-0960-006
Agency/Subagency: SSA	Agency Tracking No:
Title: Development of Participation in a Vocational Rehabilitation or Similar Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/24/2008
	Date Received in OIRA: 02/04/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	04/30/2008
Responses	3,000	0	17,000
Time Burden (Hours)	750	0	4,250
Cost Burden (Dollars)	0	0	0

---

Abstract: Regulations implementing the Ticket To Work Act allow SSA disability recipients whose disability ceases while they are enrolled in a program of vocational rehabilitation or other support services to keep receiving benefits. Form SSA-4290 is used to document the reporting requirements of these regulations by documenting the beneficiary's enrollment in a vocational rehab or work support program. The respondents are State Employment Networks, Vocational Rehabilitation Agencies, and other providers of rehab services.

---

Authorizing Statute(s): US Code: 42 USC 425 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 62510	11/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 3307	01/17/2008
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Development of Participation in a Vocational Rehabilitation or Similar Program	SSA-4290	Development of Participation in a Vocational Rehabilitation or Similar Program

---

ICR Summary 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	3,000	17,000	0	0	-14,000	0
Annual Time Burden (Hours)	750	4,250	0	0	-3,500	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 burden decrease for this ICR is due to a decrease in the number of estimated respondents. At the time of the last clearance, we had estimated a large increase in respondents due to changes in the Ticket to Work regulations. However, recent data has indicated that the actual number of respondents is much lower.

---

Annual Cost to Federal Government: $18,480

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

---

Common Form ICR:  No

---

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: 02/04/2008

---