OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

c) 20 CFR 411.200(b) - SSA-1375 (and cover letters)

IC 184457 under ICR 201506-0960-011 · OMB 0960-0644.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form SSA-1375
Ticket to Work Progress Review Form c) 20 CFR 411.200(b) - SSA-1375 (and cover letters)		 Form
SSA-L1373 - Revised Version.pdf Instruction
SSA-L1374 - Revised Version.pdf Instruction
SSA-1375 Ticket to Work Progress Review Form
SSA-1375 - Revised Version.pdf 		Form
SSA-L1373 - Current Version.pdf
Current SSA-L1373		IC Document
SSA-1375 - Current Version.pdf
Current SSA-1375		IC Document
SSA-L1374 - Current Version.pdf
Current SSA-L1374		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-1375 No   Paper Only
Instruction No   Paper Only
Instruction No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 112,362 0 0 0 0 112,362
Annual IC Time Burden (Hours) 28,091 0 0 0 0 28,091
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Current SSA-L1373 04/05/2012
Current SSA-1375 04/17/2012
Current SSA-L1374 04/17/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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