Information Collection

Work Incentives Planning and Assistance Program (WIPA)--Help Line

IC 221915 under ICR 202203-0960-011 · OMB 0960-0629.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0629 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4567 Work Incentives Planning and Assistance Program (WIPA)--Help Line	Form
SSA-4567 Help Line WIPA Referral SSA-4567 Mock-up.pdf	Form

IC Title:

Work Incentives Planning and Assistance Program (WIPA)--Help Line

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4567	Help Line WIPA Referral	SSA-4567 Mock-up.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: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-30,000	30,000
Annual IC Time Burden (Hours)	-2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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