Information Collection Request

The Ticket to Work and Self-Sufficiency Program

ICR 201809-0960-003 · OMB 0960-0644 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-1370 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Form and Instruction Modified Repair queued
Form SSA-1365 State Agency Ticket Assignment Form (SSA-1365) Form Modified Available
Form SSA-1370 c.) 20 CFR 411.200(b) Virtual Job Fair Registration - Individuals Form and Instruction Removed Repair queued
Form SSA-1370 a.) 20 CFR 411.140(d)(3) Virtual Job Fair Registration - Employment Networks Form and Instruction Removed Repair queued
Form SSA-1401 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form Modified Repair queued
Form SSA-1394 i) 20 CFR 411.320 - SSA-1394, EN Contract Changes Form and Instruction Unchanged Available
Form SSA-1391 f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1399; SSA-1398 Form and Instruction Modified Available
Form SSA-1375 c) 20 CFR 411.200(b) - SSA-1375 Form Modified Repair queued
Addendum - 0644.doc Supplementary Document Uploaded 2019-01-18 Available
Supporting Statement - 0644.docx Supporting Statement A Uploaded 2019-01-18 Available
IC Document Collections
IC IDCollectionTypeStatusForm
9680 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Form and Instruction Modified
218037 Ticket Portal Other-TTW Portal Screens Modified
218036 State Agency Ticket Assignment Form (SSA-1365) Form Modified
217179 c.) 20 CFR 411.200(b) Virtual Job Fair Registration - Individuals Form and Instruction Removed
217178 a.) 20 CFR 411.140(d)(3) Virtual Job Fair Registration - Employment Networks Form and Instruction Removed
208203 20 CFR 411.200(b) WISE Webinar Registration Page Other-online registration form Modified
203490 i) 20 CFR 411.320 - EN Contract Changes, Portal Other-Internet Screens Unchanged
201989 a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal Other-Internet Screens Unchanged
201988 a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone Unchanged
201843 f) 20 CFR 411.575 - Automatic Payments (SSA-1391 et al) Removed
201842 f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al) Modified
201841 c) 20 CFR 411.200(b) - Request for Certification of Work Portal Screens Other-Internet Screens Unchanged
201838 b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens Other-screens Unchanged
201837 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Portal Screens Other-screens Unchanged
190323 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form Modified
190204 i) 20 CFR 411.320 - SSA-1394, EN Contract Changes Form and Instruction Unchanged
184464 h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions Unchanged
184463 g) 20 CFR 411.325(f) - Periodic Outcomes Reporting Instruction Modified
184462 f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1399; SSA-1398 Form and Instruction Modified
184461 e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement Unchanged
184460 d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System Unchanged
184459 c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress Unchanged
184457 c) 20 CFR 411.200(b) - SSA-1375 Form Modified
184456 c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status Unchanged
184450 b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures Unchanged
184449 b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Other-screens Unchanged
184447 a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Other-screens Unchanged
ICR Details
0960-0644 201809-0960-003
Active 201705-0960-008
SSA
The Ticket to Work and Self-Sufficiency Program
Revision of a currently approved collection   No
Regular
Approved without change 03/21/2019
Retrieve Notice of Action (NOA) 01/18/2019
In accordance with 5 CFR 1320, the information collection is approved for three years.
  Inventory as of this Action Requested Previously Approved
03/31/2022 36 Months From Approved 03/31/2019
359,406 0 391,676
84,440 0 85,072
0 0 0

SSA’s Ticket to Work (TTW) Program transitions Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients toward independence by allowing them to receive Social Security payments while maintaining employment under the auspices of the program. SSA uses service providers, called Employment Networks (ENs), to supervise participant progress through the stages of TTW Program participation, such as job searches and interviews; progress reviews; and changes in ticket status. ENs can be private for-profit and nonprofit organizations, as well as state vocational rehabilitation agencies (VRs). SSA and the ENs utilize the TTW program manager to operate the TTW Program and exchange information about participants. For example, the ENs use the program manager to provide updates on tasks such as selecting a payment system, or requesting payments for helping the beneficiary achieve certain work goals. Since the ENs are not PRA-exempt, the multiple information collections within the TTW program manager require OMB approval. Most of the categories of information are necessary for SSA to: (1) comply with the Ticket to Work legislation; and (2) provide proper oversight of the program. SSA collects this information through several modalities, including forms, electronic exchanges, and written documentation. The respondents are the ENs or state VRs, SSDI beneficiaries, and blind or disabled SSI recipients working under the auspices of the TTW Program.

US Code: 42 USC 1320b¿19 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  83 FR 53352 10/22/2018
83 FR 66330 12/26/2018
No

24
IC Title Form No. Form Name
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 Portal Screens
State Agency Ticket Assignment Form (SSA-1365) SSA-1365 State Agency Ticket Assignment Form
Ticket Portal
c) 20 CFR 411.200(b) - Request for Certification of Work Portal Screens
f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al)
a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal
b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens
g) 20 CFR 411.325(f) - Periodic Outcomes Reporting
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1370 SSA-1370 Ticket to Work Individual Work Plan
c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status
c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress
f) 20 CFR 411.560 - SSA-1401, Split Payment Situations SSA-1401 Employment Network Split Payment Request Form
i) 20 CFR 411.320 - SSA-1394, EN Contract Changes SSA-1394 Employment Network Contract Change Form
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments
b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures
h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions
c) 20 CFR 411.200(b) - SSA-1375 SSA-1375 Ticket to Work Progress Review Form
d) 20 CFR 411.365, 411.505, 411.515 - Selecting a Payment System
f) 20 CFR 411.575 - SSA-1391; SSA-1389; SSA-1399; SSA-1398 SSA-1391, SSA-1389, SSA-1399, SSA-1398 Employment Network Payment Request Form ,   EN Services Certification Statement (For Use with Phase 1 Milestone 4 Request) ,   Auto Pay Request Form ,   Self-Employment Income (SEI) Form Beneficiary Quarterly Report Self-Employment
e) 20 CFR 411.325(d), 411.415 - Reporting Referral Agreement
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing
i) 20 CFR 411.320 - EN Contract Changes, Portal
20 CFR 411.200(b) WISE Webinar Registration Page
a.) 20 CFR 411.140(d)(3) Virtual Job Fair Registration - Employment Networks SSA-1370 Ticket to Work Virtural Job Fair Registration
c.) 20 CFR 411.200(b) Virtual Job Fair Registration - Individuals SSA-1370 Virtual Job Fair Registration - Individuals
f) 20 CFR 411.575 - Automatic Payments (SSA-1391 et al)

  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 359,406 391,676 0 0 -32,270 0
Annual Time Burden (Hours) 84,440 85,072 0 0 -632 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
When we last cleared this IC in 2017, the burden was 85,072 hours. However, we are currently reporting a burden of 84,440 hours. This change stems from three factors: (1) we removed four collection tools mentioned in #12 of the Supporting Statement; (2) a decrease in the number of responses from 24,000 to 4,812 on the Wise Webinar Registration Package; and (3) an increase in the number of responses from 112,362 to 120,000 on the SSA-1375. There is no change to the burden time per response. Although the number of responses changed, SSA did not take any actions to cause this change.

$7,000,000
No
    Yes
    Yes
No
No
No
Uncollected
Faye Lipsky 410 965-8783 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/18/2019