OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

The Ticket to Work and Self-Sufficiency Program

ICR 202401-0960-002 · OMB 0960-0644 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-1370 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370 Form and Instruction Unchanged Repair queued
Form SSA-1401 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form Unchanged Repair queued
Form SSA-1394 i) 20 CFR 411.320 - SSA-1374, EN Contract Changes Form and Instruction Unchanged Repair queued
Form SSA-1391 f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398 Form and Instruction Modified Missing upstream
Form SSA-1375 c) 20 CFR 411.200(b) - SSA-1375 Form Unchanged Repair queued
Justification for a Non-Substantive Change 0960-0644.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-18 Repair queued
Supporting Statement - 0644 (Final).docx Supporting Statement A Uploaded 2022-02-28 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
9680 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370 Form and Instruction Unchanged
251498 j) 20 CFR 411.200(b) - WISE Webinar Survey Other-Wise Survey Unchanged
251497 g) 20 CFR 411.325 (f)- Annual Performance Other-Annual Performance Outcome Report Unchanged
251496 g) 20 CFR 411.325 (f)- Certification of Services Unchanged
208203 j) 20 CFR 411.200(b) WISE Webinar Registration Page Other-online registration form Unchanged
201989 a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal Other-Internet Screens Unchanged
201988 a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone Unchanged
201837 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 State Agency Ticket Assignment Form Other-screens Unchanged
190323 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form Unchanged
190204 i) 20 CFR 411.320 - SSA-1374, EN Contract Changes Form and Instruction Unchanged
184464 h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions Unchanged
184463 g) 20 CFR 411.325(f) - Proof of Relationship Instruction Unchanged
184462 f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398 Form and Instruction Modified
184461 e) 20 CFR 411.400-411.420, 411.325(d), 411.415 - Reporting Referral Agreement Unchanged
184460 d) 20 CFR 411.505 - Selecting a Payment System Unchanged
184457 c) 20 CFR 411.200(b) - SSA-1375 Form Unchanged
184450 b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures Unchanged
184449 b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Other-screens Modified
184447 a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Other-screens Unchanged
ICR Details
StatusReceived in OIRA
Agency/SubagencySSA
OMB Control No0960-0644
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No202312-0960-002
Date Submitted to OIRA1969-12-31
Requested Expiration Date1969-12-31