Development of Participation in a Vocational Rehabilitation or Similar Program

Forms and Documents

Document	Type	Status	Availability
Form SSA-4290-F5 Development of Participation in a Vocational Rehabilitation or Similar Program (mail)	Form	Modified	Repair queued
Form SSA-4920-F5 Development of Participation in a Vocational Rehabilitation or Similar Program (telephone)	Form	New	Repair queued
Supporting Statement - 0282 (Final).docx	Supporting Statement A	Uploaded 2024-07-29	Repair queued
Addendum - 0282 (Final).docx	Supplementary Document	Uploaded 2024-07-29	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
9186	Development of Participation in a Vocational Rehabilitation or Similar Program (mail)	Form	Modified
269422	Development of Participation in a Vocational Rehabilitation or Similar Program (telephone)	Form	New

ICR Details

OMB Control No: 0960-0282	ICR Reference No: 202404-0960-010
Status: Received in OIRA	Previous ICR Reference No: 202002-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Development of Participation in a Vocational Rehabilitation or Similar Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/29/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2024
Responses	3,000	3,000
Time Burden (Hours)	2,990	750
Cost Burden (Dollars)	0	0

---

Abstract: State Disability Determination Services (DDS) determine if Social Security disability payment recipients whose disability ceased, and who participate in vocational rehabilitation programs may continue to receive disability payments. To do this, DDS need information about the recipients; the types of program participation; and the services they receive under the rehabilitation program. SSA uses Form SSA-4290-F5 to collect this information. The respondents are State employment networks, vocational rehabilitation agencies, or other providers of educational or job training services.

---

Authorizing Statute(s): US Code: 42 USC 425 Name of Law: Social Security Act
   US Code: 42 USC 1383 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 18471	03/13/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 46945	05/30/2024
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Development of Participation in a Vocational Rehabilitation or Similar Program (mail)	SSA-4290-F5	Development of Participation in a Vocational Rehabilitation or Similar Program
Development of Participation in a Vocational Rehabilitation or Similar Program (telephone)	SSA-4920-F5	Development of Participation in a Vocational Rehabilitation or Similar Program

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,000	3,000	0	0	0	0
Annual Time Burden (Hours)	2,990	750	0	0	2,240	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: When we last cleared this IC in 2021, the burden was 750 hours. However, we are currently reporting a burden of 1,900 hours. This change stems from a decrease in the completion time from 15 minutes (by phone) to 40 minutes (by mail) and 30 minutes (by phone), we this is a better estimate respondent to gather information, read the instructions, and to complete the form. Note: The total burden reflected in ROCIS is 2,990, while the burden cited in #12 of the Supporting Statement is 1,900. This discrepancy is because the ROCIS reflects the teleservice wait time + learning costs. In contrast, the chart in #12 of the Supporting Statement reflects actual burden.

---

Annual Cost to Federal Government: $32,069

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/29/2024

---