Information Collection Request

Work Incentives Planning and Assistance (WIPA)

ICR 202609-0960-011 · OMB 0960-0629 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-4565 Help Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake Form and Instruction New Available
Form SSA-4566 WIPA CASE NOTES Form Modified Available
Form SSA-4565 WIPA Intake Information Form Modified Available
Form SSA-4565 Help Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake (SSA-4565) Form Modified Available
Form SSA-4565 Wipa Case Notes Form Modified Available
10-26-26 - Comment from the National Coalition of Social Security and Supplemental Security Income Advocates - Redacted to show only the comments on 0960-0629.pdf Public Comments Uploaded 2026-10-26 Available
Supporitng Statement - 0629 (Final).docx Supporting Statement A Uploaded 2026-10-30 Available
Addendum - 0269 (Final).docx Supplementary Document Uploaded 2026-10-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
282608 WIPA STAR SYSTEM: SSA-451 (WIPA managers) Other-WIPA STAR System New
282607 WIPA STAR SYSTEM: Service management – WIPA staff Other-WIPA STAR System New
282606 WIPA STAR SYSTEM: Task management – WIPA staff Other-WIPA STAR System New
282591 WIPA case notes – WIPA staff Other-WIPA STAR System New
282590 WIPA intake – SSI & SSDI beneficiaries Other-WIPA STAR New
282589 WIPA referral data input (collected using the SSA-4565) – WIPA staff Other-WIPA STAR System New
282588 SSA-4565 (Fields 21-63 – SSI & SSDI Beneficiaries (by phone) Form and Instruction NewHelp Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake
282588 SSA-4565 (Fields 21-63 – SSI & SSDI Beneficiaries (by phone) Other-Comprehensive List of SSA-4565 Data Elements New
253857 WIPA STAR System -WIPA referral (SSI & SSDI beneficiaries) Other-WIPA Star Screens Modified
238019 Work Incentives Planning and Assistance Program (WIPA)-- SSA-4565 SSI & SDSI Beneficiaries (Fields 1-20) Form ModifiedWIPA CASE NOTES
238019 Work Incentives Planning and Assistance Program (WIPA)-- SSA-4565 SSI & SDSI Beneficiaries (Fields 1-20) Form ModifiedWIPA Intake Information
178887 WIPA STAR SYSTEM: WIPA Case Notes (SSA-4566) (WIPA Staff) Form ModifiedHelp Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake (SSA-4565)
178887 WIPA STAR SYSTEM: WIPA Case Notes (SSA-4566) (WIPA Staff) Form ModifiedWipa Case Notes

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved 10/31/2026
351,054 1,698,080
87,876 472,573
0 0





Reginfo record details
10
table that charts list of burden
IC Title Form No. Form Name
SSA-4565 (Fields 21-63 – SSI & SSDI Beneficiaries (by phone) SSA-4565
WIPA STAR SYSTEM: SSA-451 (WIPA managers)
WIPA STAR SYSTEM: Service management – WIPA staff
WIPA STAR SYSTEM: WIPA Case Notes (SSA-4566) (WIPA Staff) SSA-4565, SSA-4565 ,  
WIPA STAR SYSTEM: Task management – WIPA staff
WIPA STAR System -WIPA referral (SSI & SSDI beneficiaries)
WIPA case notes – WIPA staff
WIPA intake – SSI & SSDI beneficiaries
WIPA referral data input (collected using the SSA-4565) – WIPA staff
Work Incentives Planning and Assistance Program (WIPA)-- SSA-4565 SSI & SDSI Beneficiaries (Fields 1-20) SSA-4566, SSA-4565 ,  

table that charts list 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 351,054 1,698,080 0 0 -1,347,026 0
Annual Time Burden (Hours) 87,876 472,573 0 1 -384,698 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No