OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

The Ticket to Work and Self-Sufficiency Program

OMB 0960-0644 · SSA.

OMB 0960-0644

SSA’s Ticket to Work (TTW) Program transitions Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients toward independence by allowing them to receive Social Security payments while maintaining employment under the auspices of the program. SSA uses service providers, called Employment Networks (ENs), to supervise participant progress through the stages of TTW Program participation, such as job searches and interviews; progress reviews; and changes in ticket status. ENs can be private for-profit and nonprofit organizations, as well as state vocational rehabilitation agencies (VRs). SSA and the ENs utilize the TTW program manager to operate the TTW Program and exchange information about participants. For example, the ENs use the program manager to provide updates on tasks such as selecting a payment system, or requesting payments for helping the beneficiary achieve certain work goals. Since the ENs are not PRA-exempt, the multiple information collections within the TTW program manager require OMB approval. Most of the categories of information are necessary for SSA to: (1) comply with the Ticket to Work legislation; and (2) provide proper oversight of the program. SSA collects this information through several modalities, including forms, electronic exchanges, and written documentation. The respondents are the ENs or state VRs, SSDI beneficiaries, and blind or disabled SSI recipients working under the auspices of the TTW Program. We are making non-substantive changes to the title to be more descriptive of how the form is to be used; changing "Data Universal Numbering System (DUNS)" to Provider Identification (PID); and revising the instructions on where the form should be sent.

The latest form for The Ticket to Work and Self-Sufficiency Program expires 2026-11-30 and is listed under ICR 202403-0960-004.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SSA-1370 Ticket to Work Individual Work PlanForm and Instruction
Form SSA-1370 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370Form and Instruction
Form SSA-1401 Employment Network Split Payment Request FormForm
Form SSA-1401 f) 20 CFR 411.560 - SSA-1401, Split Payment SituationsForm
Form SSA-1394 Employment Network Contract Change FormForm and Instruction
Form SSA-1394 i) 20 CFR 411.320 - SSA-1374, EN Contract ChangesForm and Instruction
Form SSA-1389 EN Services Certification Statement (For Use with Phase 1 Milestone 4 Request)Form and Instruction
Form SSA-1391 Employment Network Payment Request FormForm and Instruction
Form SSA-1391 f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398Form and Instruction
Form SSA-1375 Ticket to Work Progress Review FormForm
Form SSA-1375 c) 20 CFR 411.200(b) - SSA-1375Form
Justification for a Non-Substantive Changes for 0960-0644.docx Justification for No Material/Nonsubstantive Change
Justification for a Non-Substantive Changes for 0960-0644.docx Justification for No Material/Nonsubstantive Change
Supporting Statement - 0644 (Final).docxSupporting Statement A
Supporting Statement - 0644 (Final).docxSupporting Statement A
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370 Form and Instruction
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370 Form and Instruction
j) 20 CFR 411.200(b) - WISE Webinar Survey Other-Wise Survey
g) 20 CFR 411.325 (f)- Annual Performance Other-Annual Performance Outcome Report
g) 20 CFR 411.325 (f)- Certification of Services Information collection
j) 20 CFR 411.200(b) WISE Webinar Registration Page Other-online registration form
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal Other-Internet Screens
a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone Information collection
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 State Agency Ticket Assignment Form Other-screens
f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form
f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form
i) 20 CFR 411.320 - SSA-1374, EN Contract Changes Form and Instruction
i) 20 CFR 411.320 - SSA-1374, EN Contract Changes Form and Instruction
h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions Information collection
g) 20 CFR 411.325(f) - Proof of Relationship Instruction
f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398 Form and Instruction
f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398 Form and Instruction
f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398 Form and Instruction
e) 20 CFR 411.400-411.420, 411.325(d), 411.415 - Reporting Referral Agreement Information collection
d) 20 CFR 411.505 - Selecting a Payment System Information collection
c) 20 CFR 411.200(b) - SSA-1375 Form
c) 20 CFR 411.200(b) - SSA-1375 Form
b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures Information collection
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Other-screens
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Other-screens

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202403-0960-004 No material or nonsubstantive change to a currently approved collection 2024-04-08 Approved without change
202401-0960-002 No material or nonsubstantive change to a currently approved collection 2024-01-18 Approved without change
202312-0960-002 No material or nonsubstantive change to a currently approved collection 2023-12-07 Approved without change
202110-0960-005 Revision of a currently approved collection 2022-02-28 Approved without change
202101-0960-002 No material or nonsubstantive change to a currently approved collection 2021-01-15 Approved without change
201809-0960-003 Revision of a currently approved collection 2019-01-18 Approved without change
201705-0960-008 No material or nonsubstantive change to a currently approved collection 2017-09-11 Approved without change
201508-0960-008 Extension without change of a currently approved collection 2015-11-19 Approved with change
201506-0960-011 No material or nonsubstantive change to a currently approved collection 2015-06-24 Approved without change
201408-0960-012 No material or nonsubstantive change to a currently approved collection 2014-08-22 Approved without change
201308-0960-009 No material or nonsubstantive change to a currently approved collection 2013-08-14 Approved without change
201207-0960-004 Revision of a currently approved collection 2012-10-26 Approved without change
201204-0960-004 Revision of a currently approved collection 2012-04-18 Approved with change
200907-0960-009 Revision of a currently approved collection 2009-12-21 Approved without change
200804-0960-005 Revision of a currently approved collection 2008-09-19 Approved with change
200505-0960-008 Extension without change of a currently approved collection 2005-05-31 Approved without change
200112-0960-003 New collection (Request for a new OMB Control Number) 2001-12-05 Approved without change

OMB Details

a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
FormNameElectronic accessType
Form SSA-1370Ticket to Work Individual Work PlanPaper OnlyForm and instruction

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