Work Incentives Planning and Assistance (WIPA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form SSA-4565 Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served)	Form	Modified	Available
Form SSA-4565 Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries	Form	New	Available
Form SSA-4566 Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served)	Form	New	Available
Form SSA-4567 Work Incentives Planning and Assistance Program (WIPA)--Help Line	Form	Modified	Available
Form SSA-4566 Work Incentives Planning and Assistance Program (WIPA)--Medium Site (150-599 beneficiaries served)	Form	Modified	Available
Supporting Statement 0629 (revised).docx	Supporting Statement A	Uploaded 2020-05-18	Available
Addendum - 0629.docx	Supplementary Document	Uploaded 2019-10-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9650	Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served)	Form	Modified
238019	Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries	Form	New
238017	Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served)	Form	New
221915	Work Incentives Planning and Assistance Program (WIPA)--Help Line	Form	Modified
178887	Work Incentives Planning and Assistance Program (WIPA)--Medium Site (150-599 beneficiaries served)	Form	Modified

ICR Details

OMB Control No: 0960-0629	ICR Reference No: 201908-0960-001
Status: Active	Previous ICR Reference No: 201604-0960-004
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: 05/18/2020
	Date Received in OIRA: 10/10/2019
Terms of Clearance: Agency updated their supporting statement and ICs.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	36 Months From Approved	05/31/2020
Responses	90,000	0	90,000
Time Burden (Hours)	25,000	0	25,000
Cost Burden (Dollars)	0	0	0

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Abstract: As part of SSA’s strategy to assist SSDI) beneficiaries and SSI recipients who wish to return to work and achieve self-sufficiency, SSA established the Work Incentives Planning and Assistance (WIPA) program. This community based, work incentive, planning and assistance project collects identifying claimant information via project sites and community work incentives coordinators (CWIC). SSA uses this information to ensure proper management of the project, with particular emphasis on administration, budgeting, and training. In addition, project sites and CWIC’s collect data from SSDI beneficiaries and SSI recipients on background employment, training, benefits, and work incentives. SSA is interested in identifying SSDI beneficiary and SSI recipient outcomes under the WIPA program, to determine the extent to which beneficiaries with disabilities and SSI recipients achieve their employment, financial, and healthcare goals. SSA will also use the data in its analysis and future planning for SSDI and SSI programs. Respondents are SSDI beneficiaries, SSI recipients, community project sites, and employment advisors.

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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:
	84 FR 34469	07/18/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 53551	10/07/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Work Incentives Planning and Assistance Program (WIPA)--Medium Site (150-599 beneficiaries served)	SSA-4565 , SSA-4566	WIPA Case Notes ,   Wipa Intake Information
Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served)	SSA-4565, SSA-4566	WIPA Beneficiary/Recipient Application ,   WIPA CASE NOTES
Work Incentives Planning and Assistance Program (WIPA)--Help Line	SSA-4567	Help Line WIPA Referral
Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries	SSA-4565	WIPA Intake Information
Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served)	SSA-4566, SSA-4565	WIPA Case Notes ,   WIPA Intake Information

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ICR Summary of Burden

table that charts list 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	90,000	0	0	0	0
Annual Time Burden (Hours)	25,000	25,000	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are no changes to the public reporting burden; however, due to changes in our internal accounting process, we are changing the way we report the information. Previously, we reported all project sites under one information collection (IC); but now, for better accounting, we are reporting them by size of the site. While this does not actually cause a burden change, it makes it easier for SSA to track the number of respondents per cite. In addition, we are replacing electronic versions of WIPA with paper Forms SSA-4565 (WIPA Intake Information); SSA-4566 (WIPA Case Note); and SSA-4567 (Help Line WIPA Referral) to collect the information we were collecting through the electronic version. Since it takes the same amount of time for respondents to use the electronic versions as it does the paper versions, there are no changes to the public reporting burden for this change.

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

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 10/10/2019

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