Information Collection

a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370

IC 9680 under ICR 202403-0960-004 · OMB 0960-0644.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
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
Form SSA-1370 Ticket to Work Individual Work Plan a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370	Form and Instruction
SSA-1370 Ticket to Work Individual Work Plan SSA1370.pdf	Form and Instruction
SSA-1370 Ticket to Work Individual Work Plan SSA1370.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 411.140(d)(3) 20 CFR 411.325(a) 20 CFR 411.150(b)(3)

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 and Instruction	SSA-1370	Ticket to Work Individual Work Plan	SSA1370.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: 26,007

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	26,007	26,007
Annual IC Time Burden (Hours)	26,007	26,007
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.