Information Collection

Work Incentive Planning and Assistance (WIPA) Customer Comment Instrument

IC 229102 under ICR 201707-0960-002 · OMB 0960-0788.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0788 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
WIPA Customer Satisfaction Instrument Sample.docx	Other-WIPA Sample
Description of WIPA Customer Satisfaction Instrument.docx Description WIPA Customer Comment Instrument	IC Document

IC Title:

Work Incentive Planning and Assistance (WIPA) Customer Comment Instrument

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Other-WIPA Sample			WIPA Customer Satisfaction Instrument Sample.docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,400	20,400
Annual IC Time Burden (Hours)	2,380	2,380
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Description WIPA Customer Comment Instrument	Description of WIPA Customer Satisfaction Instrument.docx	11/21/2017

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