Information Collection

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

IC 9680 under ICR 201506-0960-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form SSA-1370 Ticket to Work Individual Work Plan 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

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: Unchanged

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:

table that charts list of 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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,956	1,956
Annual IC Time Burden (Hours)	1,956	1,956
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.