Justification for Non-Substantive Changes to 0960-0644

Justification for Non-Substantive Changes for The Ticket to Work and Self-Sufficiency Program

20 CFR 411

OMB No. 0960-0644

SSA-1391:

• Change #1: We are removing the Certification Payment Requests option on page , and are revising the language:

• Old Language:

This form may be used to request Evidentiary Payment Requests (EPRs) or Certification Payment Requests (CPRs)

• New Language: This form may be used to request Evidentiary Payment Requests (EPRs)

Justification #1: We are removing this language, because the Social Security Administration (SSA) no longer uses the CPR form.

• Change #2: We are revising the information in the Employment Networks section on page 1:

• Old Language: DUNS

• New Language: PID

Justification #2: We are revising the language because the Social Security Administration no longer uses the Data Universal Numbering System (DUNS). The agency now uses Project IDs (PIDs).

• Change #3: We are revising the language in sections II and III on page 1.

• Old Language:

Ticket-holder Information

Ticket-holder’s name:

Ticket Number/Social Security Number

Name of Ticket Holder’s Employer

Ticket-holder achieved

• New Language:

Ticketholder Information

Ticketholder’s Name:

Ticket Number/ Social Security Number

Name of Ticketholder’s Employer

Ticketholder achieved

Justification #3: We are revising the language to correct the spelling of the word

“Ticket-holder” to the correct spelling “Ticketholder.”

• Change #4: We are revising the language on page 2 section III. Phase 1 Milestone Earnings Information (removal of an option):

• Old Language:

The beneficiary achieved less than TWL earnings and is not expected to achieve TWL earnings with in the next 2 months.

• New Language: Ticketholder achieved less than TWL but expects to achieve TWL earnings within the next 2 months.

Justification #4: We are revising the language, because this option as it is no longer applicable; if a provider chooses this option they are not eligible for payment and would not fill out this payment request form (SSA-1391).

• Change #5: We are removing language on page 2 Section IV. Payment Request Details (removal of a section):

• Removed Language:

B. Certification Payment Request- (complete Sections V and VI)

Justification #5: We are removing the language, because SSA no longer uses the CPR form.

• Change #6: We are revising the section name and instructions on page 2 Section V. EN Services Details:

• Old Language:

V. EN Services Details

• If requesting Phase 1 Milestone 1, describe in detail the services provided since the ticket assignment date.

• If requesting Phase 1 Milestone 2 or 3, describe in detail the services provided since the last milestone payment month.

• New Language:

V. Proof of Relationship Details

• If requesting Phase 1 Milestone 1, 2, 3, in the table below describe in detail the services provided with the date the services were provided during the Milestone period.

Justification #6: We are revising the language to use the term “Proof of Relationship” consistently throughout the Ticket to Work program, and requiring ENs to provide more detail about their relationships with Ticketholders and the services they provide.

• Change #7: We are removing a section VII. Certification Payment Request Details from page 2 (removal of an option):

• Removed Language:

VII. Certification Payment Request Details

Type of Certification Information (Choose one):

• Recent contact with beneficiary

• Recent contact with employer

• Attached Earnings Inquiry Request (EIR) response received from the Operations Support Manager (OSM)

• Attached information containing data from the National Directory of New Hires (NDNH) OR Unemployment Compensation Insurance Record

• Attached Self Employment Income (SEI) Form (if beneficiary is self-employed)

• Recent Contact Details (complete only if you selected “recent contact with beneficiary):

Type of contact (phone call, email, etc):________________

Date of Contact:__________________________

Description of Information you learned from contact regarding level of earnings:________________________

Justification #7: We are removing section VII. Certification Payment Request Details because we no longer use the term “Certification Payment Request” in the Ticket to Work program.

• Change #8: We are removing “Operations Support Manager,” revising the fax number and updating mailing address on page 4 in the Privacy Act Statement Collection and Use of Personal Information:

• Old Language:

Send the completed form to: Operations Support Manager (OSM) Ticket to Work, Attn: Ticket Assignment, Po Box 1433, Alexandria, VA 22313 or fax to 703-893-4149.

• New Language:

Send the completed form to: Ticket to Work, Po Box 1433, Alexandria, VA 22313 or fax to 703-893-4020.

Justification #8: We are revising the language, because the Operations Support Manger (OSM) contractor has been replaced with the Ticket Program Manager (TPM) contractor. Additionally, the fax number has been updated to the current number.

SSA-1401:

• Change #9: We are revising the information in the Employment Networks section on page 1:

• Old Language: DUNS

• New Language: PID

Justification #9: We are revising the language because the SSA no longer uses the Data Universal Numbering System (DUNS). SSA now uses Project IDs (PIDs).

• Change #10: We are revising the language under the Proposed Split Payment section on page 1 and the “note” on page 2.

• Old Language:

I want the Operation Support Manager (OSM) to make the split payment determination.

Please check the box below to indicate that you would like Operations Support Manager to determine the split payment percentages.

I want the Operations Support Manager to use the agreed upon split payment allocation chart below.

Operations Support Manager will make the actual determination regarding the allocation of payments to EN’s requesting payment for the same outcome, milestone, or reconciliation payment under its elected payment system.

• New Language:

I want the Ticket Program Manager (TPM) to make the split payment determination.

Please check the box below to indicate that you would like Ticket Program Manager to determine the split payment percentages.

I want the Ticket Program Manager to use the agreed upon split payment allocation chart below.

Ticket Program Manager will make the actual determination regarding the allocation of payments to EN’s requesting payment for the same outcome, milestone, or reconciliation payment under its elected payment system.

Justification #10: We are revising the language in these sections because the Operations Support Manger (OSM) contractor has been replaced with the Ticket Program Manager (TPM) contractor.

• Change #11: We are replacing “Beneficiary” with “Ticketholder” on pages 1 and 2.

• Old Language: Beneficiary

• New Language: Ticketholder

Justification #11: We are revising the language to be consistent with other the Ticket to Work program documents and references, where the term “Ticketholder” is used instead of “Beneficiary”.

• Change #12: We are revising the mailing address and fax number in the Collection and Use of Personal Information Privacy Act Statement section on page 3.

• Old Language:

Send the completed form to MAXIMUS Ticket to Work, Po Box 1433, Alexandria, VA 22313, or fax to 703-683-3289.

• New Language:

Send the completed form to Ticket to Work, Po Box 1433, Alexandria, VA 22313, or fax to 703-683-4020.

Justification #12: We are revising the language, because the Ticket to Work program no longer contracts with MAXIMUS. Therefore, we are changing the reference to the program name, “Ticket to Work.” We are also changing the fax number to the current fax number.

SSA will implement these changes upon OMB approval. These revisions will not affect the current burden for this information collection.

Resubmission of the Collection within One Year of OMB Approval:

We are revising the collection within a year of the OMB approval date, because we submitted the clearance package in August 2021, but only just received approval in November 2023. Since we submitted this package for clearance, the agency has stopped using DUNS, changed contractors, updated contact information, stopped using Certification Payment Request forms, and is using the term “Ticketholder” to describe Ticket to Work participants.