Information Collection Request

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

ICR 201204-0960-004 · OMB 0960-0644 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-1370 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Form and Instruction Modified Available
Form SSA-L1377 c) 20 CFR 411.200(b) - SSA-L1377 Request for Certification of Work Form and Instruction New Available
Form SSA-1392 f) 20 CFR 411.575; SSA-1392 - EN Payment Status Report Request Form and Instruction Removed Repair queued
Form SSA-1401 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form Modified Available
Form SSA-1394 i) 20 CFR 411.320 - SSA-1394, EN Contract Changes Form and Instruction Modified Repair queued
Form SSA-1365 a) 411.140(d)(3); 411.325(a); 411.150(b)(3) - SSA-1365 Form Modified Repair queued
Form SSA-1391 f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1393; SSA-1399; SSA-1396; SSA-1398 Form and Instruction Modified Repair queued
Form SSA-1375 c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374 Form Modified Repair queued
Supporting Statement - 0644.docx Supporting Statement A Uploaded 2012-04-18 Available
Emergency Clearance Request Letter - 0644.docx Supplementary Document Uploaded 2012-04-18 Repair queued
Addendum - 0644.docx Supplementary Document Uploaded 2012-04-18 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
9680 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Form and Instruction Modified
201989 a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal Other-Internet Screens New
201988 a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone New
201987 a) 20 CFR 411.140(d)(2) - Ticket Assignability - Regular Telephone New
201843 f) 20 CFR 411.575 - Automatic Payments (SSA-1391 et al) New
201842 f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al) New
201841 c) 20 CFR 411.200(b) - SSA-L1377 Portal Screens Other-Internet Screens New
201840 c) 20 CFR 411.200(b) - SSA-L1377 Request for Certification of Work Form and Instruction New
201838 b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens New
201837 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Portal Screens Other-Internet Screens New
201836 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 Portal Screens Other-Internet Screens New
191126 f) 20 CFR 411.575; SSA-1392 - EN Payment Status Report Request Form and Instruction Removed
190323 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form Modified
190204 i) 20 CFR 411.320 - SSA-1394, EN Contract Changes Form and Instruction Modified
184502 a) 411.140(d)(3); 411.325(a); 411.150(b)(3) - SSA-1365 Form Modified
184464 h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions Modified
184463 g) 20 CFR 411.325(f) - Periodic Outcomes Reporting Modified
184462 f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1393; SSA-1399; SSA-1396; SSA-1398 Form and Instruction Modified
184461 e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement Modified
184460 d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System Modified
184459 c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress Modified
184457 c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374 Form Modified
184456 c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status Modified
184450 b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures Unchanged
184449 b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Modified
184447 a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Modified
ICR Details
0960-0644 201204-0960-004
Historical Active 200907-0960-009
SSA
The Ticket to Work and Self-Sufficiency Program, 20 CFR 411
Revision of a currently approved collection   No
Emergency 05/17/2012
Approved with change 05/18/2012
Retrieve Notice of Action (NOA) 04/18/2012
  Inventory as of this Action Requested Previously Approved
11/30/2012 6 Months From Approved 04/30/2013
333,793 0 206,926
73,673 0 63,502
0 0 0

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.
ENs are anticipating the administrative efficiencies this Portal represents and may have adjusted their own resources expecting it to be available by May 1, 2012. In addition, to implement the contract reduction, we have already let some contracting staff go with the expectation that we will pilot and fully implement before we make the final contract reductions. We are requesting emergency OMB approval of the Portal to meet EN expectations and to allow sufficient time to use and ensure that the new processes work as expected before making final 2012 contract reductions. If the Portal is not available for use until late summer, it will result in reduced FY 2012 productively since it will continue to take ENs longer to submit requests and it will take us longer to process them. The inability to process ticket assignments timely would delay services to the beneficiaries. The inability to process payment requests would delay payments to EN’s and State VR’s for the services they provided beneficiaries. In addition, if the Portal is not available for use until shortly before the remaining contract reductions are made, and there are problems with transitioning to it, there will not be manpower to process ticket assignments, payment requests, and other incoming documents, or to fulfill the requests for reports. This would bottleneck or possibly suspend some daily operations. To ensure the Portal is available for EN use by May 1, 2012, we are asking for OMB approval of this Emergency Clearance by April 16, 2012.

US Code: 42 USC 405 Name of Law: Social Security Act
   US Code: 42 USC 1320b–19 Name of Law: Social Security Act
  
None

Not associated with rulemaking

77 FR 22831 04/17/2012
No

25
IC Title Form No. Form Name
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 Portal Screens
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Portal Screens
c) 20 CFR 411.200(b) - SSA-L1377 Request for Certification of Work SSA-L1377 Timely Progress Requirements to Pass Each 12-month Timely Progress Review
c) 20 CFR 411.200(b) - SSA-L1377 Portal Screens
f) 20 CFR 411.575 - Automatic Payments (SSA-1391 et al)
f) 20 CFR 411.575; SSA-1392 - EN Payment Status Report Request SSA-1392 Employment Network Payment Status Report Request Form
f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al)
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Regular Telephone
a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal
b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens
a) 411.140(d)(3); 411.325(a); 411.150(b)(3) - SSA-1365 SSA-1365 State Agency Ticket Assignment Form Ticket to Work and Self-Sufficiency Program
g) 20 CFR 411.325(f) - Periodic Outcomes Reporting
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 SSA-1370 Ticket to Work Individual Work Plan
c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status
c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress
f) 20 CFR 411.560 - SSA-1401, Split Payment Situations SSA-1401 Employment Network Split Payment Request Form
i) 20 CFR 411.320 - SSA-1394, EN Contract Changes SSA-1394 Employment Network Contract Change Form
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments
b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures
h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions
c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374 SSA-1375 Ticket to Work Progress Review Form
d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System
f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1393; SSA-1399; SSA-1396; SSA-1398 SSA-1393, SSA-1391, SSA-1389, SSA-1399, SSA-1396, SSA-1398 Employment Network Payment Request Form ,   EN Services Certification Statement (For Use with Phase 1 Milestone 4 Request) ,   Employment Network Supplemental Earnings Statement ,   Auto Pay Request Form ,   Earnings Inquiry Request Form ,   Self-Employment Income (SEI) Form Beneficiary Quarterly Report Self-Employment
e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing

  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 333,793 206,926 0 97,034 29,833 0
Annual Time Burden (Hours) 73,673 63,502 0 2,780 7,391 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Using Information Technology
We decreased the burden estimates for the paper SSA-1365 as we no longer require the use of this form for all cases. We decreased the annual reporting burden for the Request to reenter Ticket-Use Status (section c) based on more accurate data over the past year. Previously, we used a high estimate based on an educated guess, with the current data, we feel more confident in our new numbers. We reduced the response time for Selecting a Payment System (section d) as current data shows a more accurate time estimate. In addition, we increased the response time for the SSA-1389 to account for the new Part 2 we added (see Addendum for more detail). We also decreased the response time for Periodic Outcomes Reporting (section g) as we now accept this reporting electronically and we request less information since we capture some information as a by-product of operational activity. Finally, we are adding the new Secure Provider Portal which will decrease the time burden for some of the collections listed above (see Addendum for more details). We estimate approximately half of all respondents will use the Portal rather than the paper forms. All other increases and decreases to our burden estimates are based on current actual response data. We base our estimates on the average two-year actual responses (from the previous two years) for each instrument divided by two.

$7,000,000
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/18/2012