Information Collection Request

Work Incentives Planning and Assistance (WIPA)

ICR 202203-0960-011 · OMB 0960-0629 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-4566 WIPA CASE NOTES Form Removed Repair queued
Form SSA-4565 WIPA Beneficiary/Recipient Application Form Removed Repair queued
Form SSA-4565 Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served) Form Removed Repair queued
Form SSA-4566 WIPA CASE NOTES Form Modified Repair queued
Form SSA-4565 WIPA Intake Information Form Modified Repair queued
Form SSA-4565 Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565) Form Modified Repair queued
Form SSA-4566 WIPA Case Notes Form Removed Repair queued
Form SSA-4565 WIPA Intake Information Form Removed Repair queued
Form SSA-4565 Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served) Form Removed Repair queued
Form SSA-4567 Help Line WIPA Referral Form Removed Repair queued
Form SSA-4567 Work Incentives Planning and Assistance Program (WIPA)--Help Line Form Removed Repair queued
Form SSA-4565 Help Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake (SSA-4565) Form Modified Repair queued
Form SSA-4565 Wipa Case Notes Form Modified Repair queued
Form SSA-4565 WIPA Case Notes (SSA-4566) Form Modified Repair queued
Supporting Statement 0960-0629 (Final).docx Supporting Statement A Uploaded 2022-06-02 Repair queued
Addendum to Supporting Statement 0960-0629.docx Supplementary Document Uploaded 2022-05-25 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
9650 Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served) Form RemovedWIPA CASE NOTES
9650 Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served) Form RemovedWIPA Beneficiary/Recipient Application
9650 Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served) Form Removed
253857 WIPA STAR System Other-WIPA Star Screens New
238019 Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565) Form ModifiedWIPA CASE NOTES
238019 Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565) Form ModifiedWIPA Intake Information
238019 Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565) Form Modified
238017 Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served) Form RemovedWIPA Case Notes
238017 Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served) Form RemovedWIPA Intake Information
238017 Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served) Form Removed
221915 Work Incentives Planning and Assistance Program (WIPA)--Help Line Form RemovedHelp Line WIPA Referral
221915 Work Incentives Planning and Assistance Program (WIPA)--Help Line Form Removed
178887 WIPA Case Notes (SSA-4566) Form ModifiedHelp Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake (SSA-4565)
178887 WIPA Case Notes (SSA-4566) Form ModifiedWipa Case Notes
178887 WIPA Case Notes (SSA-4566) Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2026 36 Months From Approved 10/31/2023
1,698,080 0 90,000
472,573 0 25,000
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
WIPA Case Notes (SSA-4566) SSA-4565, SSA-4565 ,  
WIPA STAR System
Work Incentives Planning and Assistance Program (WIPA) - Large Site (600 or more beneficiaries served) SSA-4566, SSA-4565 ,  
Work Incentives Planning and Assistance Program (WIPA)- (Small Site Under 150 Beneficiaries served) SSA-4566 , SSA-4565 ,  
Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565) SSA-4566, SSA-4565 ,  
Work Incentives Planning and Assistance Program (WIPA)--Help Line SSA-4567

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 1,698,080 90,000 0 -50,500 1,658,580 0
Annual Time Burden (Hours) 472,573 25,000 0 -9,167 456,740 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No