The Ticket to Work and Self-Sufficiency Program, 20 CFR 411

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-1365 State Agency Ticket Assignment Form Ticket to Work and Self-Sufficiency Program	Form	New	Available
Electronic Data Exchange Response for Progress Reports (Draft Version)	Form	New	Available
Form SSA-1375 Ticket to Work Progress Review Form	Form	New	Repair queued
Form SSA-1375 Ticket to Work Progress Review Form	Form	New	Available
Addendum--0644.doc	Supplementary Document	Uploaded 2008-09-18	Available
0960-0641--Memo Dated 08-31-2005.doc	Supplementary Document	Uploaded 2008-09-16	Repair queued
Current SSA-1365.pdf	Supplementary Document	Uploaded 2008-09-16	Available
Supporting Statement--0644.doc	Supporting Statement A	Uploaded 2008-09-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9680	20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a)		Modified
184502	411.140(d)(3); 411.385(a); 411.390 -- SSA-1365	Form	New	State Agency Ticket Assignment Form Ticket to Work and Self-Sufficiency Program
184464	20 CFR 411.435, 411.615, 411.635		New
184463	20 CFR 411.325(f)		New
184462	20 CFR 411.575		New
184461	20 CFR 411.325(d), 411.415		New
184460	20 CFR 411.365, 411.505, 411.515		New
184459	20 CFR 411.210(b)		New
184458	20 CFR 411.200(b)--SSA-1375 Internet Version (State ENs)	Form	New	Electronic Data Exchange Response for Progress Reports (Draft Version)
184458	20 CFR 411.200(b)--SSA-1375 Internet Version (State ENs)	Instruction	New
184458	20 CFR 411.200(b)--SSA-1375 Internet Version (State ENs)	Form	New	Ticket to Work Progress Review Form
184457	20 CFR 411.200(b)--SSA-1375 (Beneficiaries)	Instruction	New
184457	20 CFR 411.200(b)--SSA-1375 (Beneficiaries)	Form	New	Ticket to Work Progress Review Form
184456	20 CFR 411.192(b)&(c)		New
184450	20 CFR 411.535(a)(1)(iii)		New
184449	20 CFR 411.145 & 411.325		New
184447	20 CFR 411.170(b); 411.385(a); 411.390		New

ICR Details

OMB Control No: 0960-0644	ICR Reference No: 200804-0960-005
Status: Historical Active	Previous ICR Reference No: 200505-0960-008
Agency/Subagency: SSA	Agency Tracking No:
Title: The Ticket to Work and Self-Sufficiency Program, 20 CFR 411
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: 12/17/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/19/2008
Terms of Clearance: OMB is extending its approval of this collection for only one year. For the next submission of the 0960-0644 ICR package to OMB, SSA will review all of the Ticket to Work and Self-Sufficiency Program’s information collection instruments that respondents use (forms and instructions) and include them in the ICR package with the corresponding burden calculations.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	36 Months From Approved	12/31/2008
Responses	121,981	0	248,664
Time Burden (Hours)	46,553	0	993,384
Cost Burden (Dollars)	0	0	0

---

Abstract: Through its Ticket to Work Program Manager, SSA uses the information collected to operate and manage the Ticket to Work Program. SSA uses the Ticket to Work Program to assign Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) beneficiaries to a service provider, and follows their progress through the various stages of ticket program participation such as progress reviews or changes in ticket status. Most of the collections in this request require service providers to provide information to SSA for such tasks as selecting a payment system or requesting payments for helping the beneficiary achieve certain work goals. Most of the categories of information collected in this request are required for SSA to be in compliance with the Ticket to Work legislation and provide proper oversight of the program. The respondents are SSDI beneficiaries and blind or disabled SSI beneficiaries and their employment networks or State vocational rehabilitation agencies under the Ticket to Work Program.

---

Authorizing Statute(s): US Code: 42 USC 405
   US Code: 42 USC 1320b–19
  

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:
	73 FR 24340	05/02/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 49730	08/22/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a)
20 CFR 411.145 & 411.325
20 CFR 411.170(b); 411.385(a); 411.390
20 CFR 411.192(b)&(c)
20 CFR 411.200(b)--SSA-1375 (Beneficiaries)	SSA-1375	Ticket to Work Progress Review Form
20 CFR 411.200(b)--SSA-1375 Internet Version (State ENs)	N/A, SSA-1375	Ticket to Work Progress Review Form ,   Electronic Data Exchange Response for Progress Reports (Draft Version)
20 CFR 411.210(b)
20 CFR 411.325(d), 411.415
20 CFR 411.325(f)
20 CFR 411.365, 411.505, 411.515
20 CFR 411.435, 411.615, 411.635
20 CFR 411.535(a)(1)(iii)
20 CFR 411.575
411.140(d)(3); 411.385(a); 411.390 -- SSA-1365	SSA-1365	State Agency Ticket Assignment Form Ticket to Work and Self-Sufficiency Program

---

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	121,981	248,664	0	35,505	-162,188	0
Annual Time Burden (Hours)	46,553	993,384	0	5,884	-952,715	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: The annual reporting burden for these information collections have changed. We are making a couple program changes from the Amendments to the Ticket to Work and Self-Sufficiency Program (967F) (see Addendum). In general, SSA has adjusted the burden hours based primarily on the use of better management information about the number of respondents and the average burden per response. In addition, the use of electronic data sharing has significantly lowered the burden associated with the two largest information collections in this request. Finally, we are combining this collection with OMB Control No. 0960-0641 (for SSA-1365), which is a program change that increases the burden.

---

Annual Cost to Federal Government: $0

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: 09/19/2008

---