Information Collection

WIPA Provider Survey

IC 278836 under ICR 202601-0960-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A2a - WIPA Provider Survey Invitation Letter (Week 1).docx	Other-Survey Invitaton Email (Week 1
Attachment A2a - WIPA Provider Survey Invitation Letter (Week 1).docx	Other-Survey Invitaton Email (Week 1
Attachment A2b - WIPA Provider Survey Invitation Email (Week 1.5).docx	Other-Survey Invitation Email (Week
Attachment A2b - WIPA Provider Survey Invitation Email (Week 1.5).docx	Other-Survey Invitation Email (Week
Attachment A2c - WIPA Provider Survey Reminder Email (Week 3).docx	Other-Survey Invitation Email (Week
Attachment A2c - WIPA Provider Survey Reminder Email (Week 3).docx	Other-Survey Invitation Email (Week
Attachment A2d - WIPA Provider Survey Reminder Email (Week 4.5).docx	Other-Survey Invitation Email (Week
Attachment A2d - WIPA Provider Survey Reminder Email (Week 4.5).docx	Other-Survey Invitation Email (Week
Attachment A2e - WIPA Provider Survey Reminder Email (Week 6).docx	Other-Survey Invitation Email (Week
Attachment A2e - WIPA Provider Survey Reminder Email (Week 6).docx	Other-Survey Invitation Email (Week
Attachment A2f - WIPA Provider Survey Reminder Email (Week 7.5).docx	Other-Survey Invitation Email (Week
Attachment A2f - WIPA Provider Survey Reminder Email (Week 7.5).docx	Other-Survey Invitation Email (Week
Attachment A2g - WIPA Provider Survey Instrument.docx	Other-Survey Instrument
Attachment A2g - WIPA Provider Survey Instrument (Revised Clean Copy).docx	Other-Survey Instrument

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Invitaton Email (Week 1)	Yes	No	Printable Only
Other-Survey Invitation Email (Week 1.5)	Yes	No	Printable Only
Other-Survey Invitation Email (Week 3)	Yes	No	Printable Only
Other-Survey Invitation Email (Week 4.5)	Yes	No	Printable Only
Other-Survey Invitation Email (Week 6)	Yes	No	Printable Only
Other-Survey Invitation Email (Week 7.5)	Yes	No	Printable Only
Other-Survey Instrument	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	59	59
Annual IC Time Burden (Hours)	37	37
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.

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