National Disability Forum and Surveys (NDF)

National Disability Forum Approved, OMB Number 0960-0788 1

Disability Forum Evaluation

Exploring Potential Changes to the Ticket to Work Program Regulations

Demographics

OMB Number 0960-0788

Thank you for taking the time to participate in this evaluation. Your comments will enable us to improve future forums and tailor them to meet your expectations.

1. Your organization type:

Government - SSA only

Government - other than SSA Business

Nonprofit

College/University Health care

Faith-based Military

Other (please specify)

2. How did you learn about the forum?

I received an email from SSA

A work colleague told me about it

I saw it on the socialscurity.gov website I saw it on social media

Other (Please specify)

3. How did you participate in this forum?

In person By phone

3. On a scale of 1 to 5, with 5beingthebestscore and 1beingtheworstscore , how would you rate the following aspects of the forum?

1 2 3 4 5

Forum overall

Clarity Content

Format/Structure Length

Location

Opportunity for audience participation

Usefulness of the topic Discussions

3. If you rated any of the items in Question 4 above as "1" or "2," please explain why.

Disability Forum Evaluation

Exploring Potential Changes to the Ticket to Work Program Regulations

Future Forums

6. What topics would you like to discuss at future Disability Forums?

Topic 1

Topic 2

Topic 3

Disability Forum Evaluation

Exploring Potential Changes to the Ticket to Work Program Regulations

Communication Resources

7. How do you typically review news and information about SSA? (Select all that apply)

SSA website SSA emails Social media Newspapers

Congressional testimony "Social Security Matters" blog Other

(Please specify)

7. Do you follow Social Security on:

Facebook Twitter LinkedIn

I do not follow Social Security

Disability Forum Evaluation

Exploring Potential Changes to the Ticket to Work Program Regulations

Contact Information

9. Your contact information (optional)

Name

Email address

Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions (OR participate in this focus group OR complete this telephone survey) unless we display a valid Office of Management and Budget control number. We estimate that it will take about 2 minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.