Work Incentives Planning and Assistance (WIPA)

Forms and Documents

Document Name	Status
Work Incentives Planning and Assistance Program (WIPA)--Beneficiaries Form	Modified
Work Incentives Planning and Assistance Program (WIPA)--Help Line Form	New
Work Incentives Planning and Assistance Program (WIPA)--Project Sites and CWICs Form	Modified
Supporting Statement - 0629.docx Supporting Statement A	2016-10-14
Addendum - 0629.docx Supplementary Document	2016-07-22

IC Document Collections

IC ID	Document Title	Status
9650	Work Incentives Planning and Assistance Program (WIPA)--Beneficiaries Form	Modified
221915	Work Incentives Planning and Assistance Program (WIPA)--Help Line Form	New
178887	Work Incentives Planning and Assistance Program (WIPA)--Project Sites and CWICs Form	Modified

ICR Details

OMB Control No: 0960-0629	ICR Reference No: 201604-0960-004
Status: Historical Active	Previous ICR Reference No: 201305-0960-013
Agency/Subagency: SSA	Agency Tracking No:
Title: Work Incentives Planning and Assistance (WIPA)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/22/2016
	Date Received in OIRA: 07/22/2016
Terms of Clearance: This collection is approved based on the revised materials provided by the Agency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2019	36 Months From Approved	10/31/2016
Responses	90,000	0	40,496
Time Burden (Hours)	25,000	0	20,159
Cost Burden (Dollars)	0	0	0

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Abstract: SSA's Work Incentives Planning and Assistance (WIPA) program collects identifying information from project sites and the community work incentives coordinators for the purpose of administering community outreach programs designed to assist Social Security disability claimants and Supplemental Security Income (SSI) recipients who may want to return to work and achieve self-sufficiency. In addition, we collect data from claimants/recipients on background employment, training, benefits, and work incentives. SSA is interested in identifying outcomes under the WIPA program to determine the extent to which individuals with disabilities achieve their employment, financial, and health care goals. The data we collect is also valuable for analysis and future planning for Social Security Disability Insurance and SSI programs.

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Authorizing Statute(s): US Code: 42 USC 1320b-20 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 24927	04/27/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 46752	07/18/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Work Incentives Planning and Assistance Program (WIPA)--Beneficiaries	N/A, N/A	WIPA Beneficiary/Recipient Application ,   ETO System Fields
Work Incentives Planning and Assistance Program (WIPA)--Project Sites and CWICs	N/A, N/A , N/A	Work Incentives Planning and Assistance formerly BPAO ,   Work Incentives Planning and Assistance Community Work Incentives Coordinator (CWIC) Form ,   ETO System Fields
Work Incentives Planning and Assistance Program (WIPA)--Help Line	N/A	ETO System Fields

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ICR Summary of Burden

	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	90,000	40,496	0	49,504	0	0
Annual Time Burden (Hours)	25,000	20,159	0	4,841	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The burden changed, due to adding the Help Line to complete the "Add a Beneficiary" form in ETO, as well as reducing the response burden time from 30 to 20 minutes per response for the CWICs. The response time was reduced due to removing and merging duplicate fields and forms.

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Annual Cost to Federal Government: $23,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/22/2016

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