Information Collection

a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370

IC 9680 under ICR 201408-0960-012 · OMB 0960-0644.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0644 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1370 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Form and Instruction
SSA-1370 Ticket to Work Individual Work Plan SSA-1370 - Revised Version.pdf Form and Instruction
SSA-1370 - Current Version.pdf Current SSA-1370 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 411.325(a) 20 CFR 411.150(b)(3) 20 CFR 411.140(d)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	SSA-1370	Ticket to Work Individual Work Plan	SSA-1370 - Revised Version.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,956	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,956	391	1,565
Annual IC Time Burden (Hours)	1,956	391	1,565
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Current SSA-1370	SSA-1370 - Current Version.pdf	08/03/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.