Information Collection

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

IC 9186 under ICR 202404-0960-010 · OMB 0960-0282.

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 404.1596 20 CFR 416.1338(c)-(d) 20 CFR 404.316(c) 20 CFR 404.337(c) 20 CFR 404.352(d) 20 CFR 404.1597(a) 20 CFR 404.1586(g) 20 CFR 416.1320(d) 20 CFR 416.1331(a)-(b) 20 CFR 416.1338 20 CFR 404.327 20 CFR 404.328

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-4290-F5	Development of Participation in a Vocational Rehabilitation or Similar Program	SSA-4290-F5 (revised).pdf		Yes	No	Fillable Printable
Other-Revised Privacy Act Statement 0577			0960-0282 Privacy Act Statement (revised).docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,400

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	Previously Approved
Annual Number of Responses for this IC	2,400	-600	3,000
Annual IC Time Burden (Hours)	2,200	1,450	750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA-4290-F5 Current Version	SSA-4290-F5 (current).pdf	07/17/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.