Ticket to Work Program Evaluation Survey (National Beneficiary Survey)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0960-0666 Addendum.doc	Supplementary Document	Uploaded 2009-12-09	Available
0960-0666 supporting statement B (2009).doc	Supporting Statement B	Uploaded 2009-12-09	Available
0960-0666 supporting statement A.doc (2009).doc	Supporting Statement A	Uploaded 2009-12-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9716	National Beneficiary Survey -- National Beneficiary Sample	Other-Advance Letter to Participants	Modified
191517	National Beneficiary Survey -- Ticket Participant Sample	Other-Advance Letter to Participants	New

ICR Details

OMB Control No: 0960-0666	ICR Reference No: 200912-0960-004
Status: Historical Active	Previous ICR Reference No: 200602-0960-011
Agency/Subagency: SSA	Agency Tracking No:
Title: Ticket to Work Program Evaluation Survey (National Beneficiary Survey)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/11/2010
	Date Received in OIRA: 12/10/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	36 Months From Approved
Responses	5,400	0	0
Time Burden (Hours)	4,551	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: In this ICR, we are seeking clearance for round 4 of the National Beneficiary Survey and two associated experiments (all three activities will use the same data). We are conducting these surveys as part of the multi-phase evaluation of the Ticket to Work program, established as per the mandates of the 1999 Ticket to Work Incentives Improvement Act, Public Law 106-170. The respondents are Social Security beneficiaries and TTW enrollees. As with the previous three phases of this project, a contractor will conduct this study for SSA.

---

Authorizing Statute(s): PL: Pub.L. 106 - 170 101(a) Name of Law: The 1999 Ticket to Work and Work Incentives Improvement Act
   PL: Pub.L. 106 - 170 101(d)(4)(A) Name of Law: The 1999 Ticket to Work and Work Incentives Improvement 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:
	74 FR 41959	08/19/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 55080	10/26/2009
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
National Beneficiary Survey -- National Beneficiary Sample
National Beneficiary Survey -- Ticket Participant Sample

---

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	5,400	0	0	5,400	0	0
Annual Time Burden (Hours)	4,551	0	0	4,551	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: ROCIS registers all 4,551 burden hours of this ICR as a burden increase because we previously discontinued this collection, so ROCIS thinks the burden is zero. There is an actual small burden increase compared to the last iteration of this survey we conducted, because we added a few questions to the survey. However, the actual change is minimal. Please note that ROCIS's burden is 1 hour greater than the burden reported in the Supporting Statement due to ROCIS's rounding methodology.

---

Annual Cost to Federal Government: $1,952,137

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)? No

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: 12/10/2009

---