Information Collection

Development of Participation in a Vocational Rehabilitation or Similar Program (telephone)

IC 269422 under ICR 202404-0960-010 · OMB 0960-0282.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-4920-F5 Development of Participation in a Vocational Rehabilitation or Similar Program (telephone)	Form
0960-0282 Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
0960-0282 Privacy Act Statement (revised).docx	Other-Privacy Act Statement (revised
SSA-4920-F5 Development of Participation in a Vocational Rehabilitat SSA-4290-F5 (revised).pdf	Form
SSA-4920-F5 Development of Participation in a Vocational Rehabilitat SSA-4290-F5 (revised).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	SSA-4920-F5	Development of Participation in a Vocational Rehabilitation or Similar Program	SSA-4290-F5 (revised).pdf		No		Paper Only
Other-Privacy Act Statement (revised)			0960-0282 Privacy Act Statement (revised).docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	790	790
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.