Memo Dated 08-31-2005 (per the Term of Clearance for 0960-0641)

From: Davidson, Liz

Sent: Wednesday, August 31, 2005 3:48 PM

To: Potter, Rachel F.

Cc: O'Leary, Paul; Payne, Suzanne; Lebowitz, Naomi; Lipsky, Faye

Subject: Questions 0960-0641

Importance: High

Rachel,

Below is our response to both questions.

QUESTION 1) Our addendum states that the SSA-1366 and SSA-1367 have been made obsolete, Why were these forms obsoleted.

SSA developed forms SSA-1366 and SSA-1367 to simplify the way in which state vocational rehabilitation agencies (SVRAs) and Employment Networks (ENs) are required to submit information on disability beneficiaries receiving the organization's rehabilitation and/or return to work services as part of the Ticket program. These were voluntary forms developed to facilitate data collection mandated by P.L. 106-170.

The SVRAs and ENs rejected the SSA-1366 and SSA 1367 forms. These organizations opted to submit the required information in formats of their choosing, though primarily they are received in a narrative. The collection of this information is authorized by 20 CFR 411.140, 411.325, 411.370 and 411.385 and is cleared under OMB No. 0960-0644, Ticket to Work and Self-Sufficiency Program. SSA decided to obsolete the forms because there was no interest in using them.

QUESTION 2) The number of tickets, 50, for each respondent appears to be low. Is this correct?

Response: We have reevaluated the burden information and are revising it based on current data:

Form SSA-1365 is used by approximately 82 respondents who report approximately 307 times each annually for a total of 25,174 annual responses. The estimated average response time is 3 minutes, for a total of 1,259 burden hours. The total burden is reflected as burden hours, and no separate cost burden has been calculated.

Please let me know if you have any questions.

Liz Davidson

Team Leader, Reports Clearance Team

DCFAM, OPLM, OPUM

410-965-0454

Pager:  410-909-8175

Fax:  410-965-6400