f) 20 CFR 411.560 - SSA-1401, Split Payment Situations

The Ticket to Work and Self-Sufficiency Program

OMB: 0960-0644

IC ID: 190323

Information Collection (IC) Details

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f) 20 CFR 411.560 - SSA-1401, Split Payment Situations
 
No Modified
 
Mandatory
 
20 CFR 411.560

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-1401 Employment Network Split Payment Request Form SSA-1401 (revised).pdf Yes No Printable Only

Income Security General Retirement and Disability

 

5 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5 0 0 0 0 5
Annual IC Time Burden (Hours) 2 0 0 0 0 2
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current SSA-1401 SSA-1401 (current).pdf 03/25/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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