Information Collection

Plan to Achieve Self-Support (PASS)

IC 9490 under ICR 202206-0960-007 · OMB 0960-0559.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-545 Plan to Achieve Self-Support (PASS)	Form
SSA-545-BK - Revised PRA Statement.pdf	Other-Revised PRA Statement
SSA-545 Plan to Achieve Self-Support SSA-545-BK - Revised Version.pdf	Form
SSA-545-BK - Current Version.pdf SSA-545 - Current	IC Document

IC Title:

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

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-545	Plan to Achieve Self-Support	SSA-545-BK - Revised Version.pdf		No		Paper Only
Other-Revised PRA Statement			SSA-545-BK - Revised PRA 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 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	7,000	0	7,000
Annual IC Time Burden (Hours)	20,300	6,300	14,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-545 - Current	SSA-545-BK - Current Version.pdf	11/01/2022

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