Addendum - 0644

Addendum - 0644.doc

The Ticket to Work and Self-Sufficiency Program

Addendum - 0644

OMB: 0960-0644

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Addendum to Supporting Statement for

The Ticket to Work and Self-Sufficiency Program

20 CFR 411

OMB No. 0960-0644



Revisions to the Collection Instrument


SSA is making the following revisions:


  • Change #1: We are removing the following data collections from this clearance package:

  • Virtual Job Fair Registration Form

  • Automatic Payment Request Form

  • SSA-1396 (Earnings Inquiry Request Form)

  • SSA-1393 (Employment Network Supplemental Earnings Statement)

  • Justification #1: We no longer conduct virtual job fairs or require a form submission for enrollment in automatic payments. Additionally, we now confirm earnings via the secured Ticket Portal, instead of a form.

  • Change #2: We are revising the PRA statements on Forms SSA-1365, SSA-1389, SSA‑1391, SSA-1398, SSA-1399, and SSA-1401.


Justification #2: We are revising the PRA statements to reflect our current boilerplate language.  The current language, which dates back to the last reprint of the forms, are now outdated.


  • Change #3: We are revising the Privacy Act Statements on Forms SSA-1365, SSA-1370, SSA-1375, SSA-1389, SSA-1391, SSA-1398, SSA-1399, and SSA-1401.


Justification #3: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statements on the forms.

  • Change #4: We are revising the Privacy Act Statement on the Ticket to Work Portal Screen package.


Justification #4: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the screen package.


  • Change #5: We are revising the Privacy Act Statements on the Timely Progress Review Notices.


Justification #5: SSA’s Office of the General Counsel is conducting a systematic review of SSA’s Privacy Act Statements on agency forms. As a result, SSA is updating the Privacy Act Statement on the Timely Progress Review Notices.

File Typeapplication/msword
File TitleAddendum to the Supporting Statement for Form SSA-3462
Author177717
Last Modified BySYSTEM
File Modified2019-01-18
File Created2019-01-18

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