Information Collection

Plan to Achieve Self-Support (PASS)

IC 9490 under ICR 201904-0960-001 · OMB 0960-0559.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0559 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-545 Plan to Achieve Self-Support (PASS) Form
Revised PA Statement.pdf Other-Revised PA Statement
SSA-545 Plan to Achieve Self-Support SSA-545-BK - Revised.pdf Form
SSA-545-BK - Current.pdf SSA-545 - Current IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Plan to Achieve Self-Support (PASS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 416.1225-416.1227 20 CFR 416.1180-416.1182 20 CFR 416.110(e)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-545	Plan to Achieve Self-Support	SSA-545-BK - Revised.pdf		No		Paper Only
Other-Revised PA Statement			Revised PA Statement.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: 7,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,000	7,000
Annual IC Time Burden (Hours)	14,000	14,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SSA-545 - Current	SSA-545-BK - Current.pdf	06/05/2019

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