OMB control number

Work Incentives Planning and Assistance (WIPA)

OMB 0960-0629 · SSA.

OMB 0960-0629

As part of SSA’s strategy to assist SSDI) beneficiaries and SSI recipients who wish to return to work and achieve self-sufficiency, SSA established the Work Incentives Planning and Assistance (WIPA) program. This community based, work incentive, planning and assistance project collects identifying claimant information via project sites and community work incentives coordinators (CWIC). SSA uses this information to ensure proper management of the project, with particular emphasis on administration, budgeting, and training. In addition, project sites and CWIC’s collect data from SSDI beneficiaries and SSI recipients on background employment, training, benefits, and work incentives. SSA is interested in identifying SSDI beneficiary and SSI recipient outcomes under the WIPA program, to determine the extent to which beneficiaries with disabilities and SSI recipients achieve their employment, financial, and healthcare goals. SSA will also use the data in its analysis and future planning for SSDI and SSI programs. Respondents are SSDI beneficiaries, SSI recipients, community project sites, and employment advisors. We are making a non-substantive change request to the WIPA Case notes to enhance task tracking for users and to strengthen the oversight and management capabilities for WIPA.

The latest form for Work Incentives Planning and Assistance (WIPA) expires 2026-11-30 and is listed under ICR 202604-0960-007.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-4565 Help Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA IntakeForm and Instruction
Form SSA-4566 WIPA CASE NOTESForm
Form SSA-4565 WIPA Intake InformationForm
Form SSA-4565 Help Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake (SSA-4565)Form
Form SSA-4565 Wipa Case NotesForm
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.pdfPublic Comments
Supporitng Statement - 0629 (Final).docxSupporting Statement A
Addendum - 0269 (Final).docxSupplementary Document
WIPA STAR SYSTEM: SSA-451 (WIPA managers) Other-WIPA STAR System
WIPA STAR SYSTEM: Service management – WIPA staff Other-WIPA STAR System
WIPA STAR SYSTEM: Task management – WIPA staff Other-WIPA STAR System
WIPA case notes – WIPA staff Other-WIPA STAR System
WIPA intake – SSI & SSDI beneficiaries Other-WIPA STAR
WIPA referral data input (collected using the SSA-4565) – WIPA staff Other-WIPA STAR System
SSA-4565 (Fields 21-63 – SSI & SSDI Beneficiaries (by phone) Other-Comprehensive List of SSA-4565 Data Elements
SSA-4565 (Fields 21-63 – SSI & SSDI Beneficiaries (by phone) Form and Instruction
WIPA STAR System -WIPA referral (SSI & SSDI beneficiaries) Other-WIPA Star Screens
Work Incentives Planning and Assistance Program (WIPA)-- SSA-4565 SSI & SDSI Beneficiaries (Fields 1-20) Form
Work Incentives Planning and Assistance Program (WIPA)-- SSA-4565 SSI & SDSI Beneficiaries (Fields 1-20) Form
WIPA STAR SYSTEM: WIPA Case Notes (SSA-4566) (WIPA Staff) Form
WIPA STAR SYSTEM: WIPA Case Notes (SSA-4566) (WIPA Staff) Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202609-0960-011 Revision of a currently approved collection 2026-10-30
202604-0960-007 No material or nonsubstantive change to a currently approved collection 2026-07-22
202203-0960-011 Revision of a currently approved collection 2022-06-02 Approved without change
201908-0960-001 Revision of a currently approved collection 2019-10-10 Approved with change
201604-0960-004 Revision of a currently approved collection 2016-07-22 Approved with change
201305-0960-013 Revision of a currently approved collection 2013-07-12 Approved without change
201304-0960-004 No material or nonsubstantive change to a currently approved collection 2013-04-17 Approved without change
201104-0960-012 No material or nonsubstantive change to a currently approved collection 2011-04-29 Approved without change
201103-0960-020 No material or nonsubstantive change to a currently approved collection 2011-03-24 Approved without change
201011-0960-008 No material or nonsubstantive change to a currently approved collection 2010-11-25 Approved without change
201001-0960-002 Revision of a currently approved collection 2010-04-29 Approved without change
200701-0960-012 Revision of a currently approved collection 2007-03-30 Approved with change
200403-0960-009 Extension without change of a currently approved collection 2004-03-12 Approved without change
200011-0960-006 New collection (Request for a new OMB Control Number) 2000-11-22 Approved without change

OMB Details

WIPA Case Notes (SSA-4566)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-4565Help Line Work Incentives Planning and Assistance (WIPA) Referral and WIPA Intake (SSA-4565)Fillable FileableForm
Form SSA-4565Wipa Case NotesFillable Fileable SignableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.