c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374; SSA-L1377

The Ticket to Work and Self-Sufficiency Program, 20 CFR 411

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0644 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-1375 c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374; SSA-L1377 Form
SSA-L1373 Notice Q2 - Beneficiary TPR Cover ltr 05-14-2009 revised.doc Instruction
SSA-L1374 Notice F1 - Beneficiary Fail 05-14-2009 revised.doc Instruction
SSA-L1377.pdf Instruction
SSA-1375 Ticket to Work Progress Review Form SSA-1375.pdf Form

Information Collection (IC) Details

IC Title:	c) 20 CFR 411.200(b) - SSA-1375; SSA-L1373; SSA-L1374; SSA-L1377	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 411.200(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSA-1375	Ticket to Work Progress Review Form	SSA-1375.pdf	No	Paper Only
Instruction			SSA-L1373 Notice Q2 - Beneficiary TPR Cover ltr 05-14-2009 revised.doc	No	Paper Only
Instruction			SSA-L1374 Notice F1 - Beneficiary Fail 05-14-2009 revised.doc	No	Paper Only
Instruction			SSA-L1377.pdf	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 127,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	127,000	113,500	13,500
Annual IC Time Burden (Hours)	31,750	28,375	3,375
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.