National Disability Forum and Surveys (NDF)

NDF OMB Package Approved, OMB Number 0960-0788 1

NationalDisability Forum

Exploring Potential Changes to the Ticket to Work Program Regulations

Wednesday, April 5, 2017 National Education Association

Chanin Auditorium (Level B3) 1201 16th Street, NW Washington, DC 20036

1:00 p.m. to 3:00 p.m. EDT

• ^{1. Title}

• ^{2. First name}

3. MI

• ^{4. Last name}

5. Suffix

• ^{6. Phone number}

• ^{7. Email address}

Enter email address

Verify email address

• ^{8. Name of your organization}

• ^{9. Organization Type}

• ^{10. Job title}

• ^{11. Are you an employee of the Social Security Administration (SSA)?}

Yes No

• ^{12. Do you require special accommodation?}

Yes No

If yes, please explain:

• ^{13. How did you hear about this event?}

14. Twitter handle

“Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions (OR participate in this focus group OR complete this telephone survey) unless we display a valid Office of Management and Budget control number. We estimate that it will take about 2 minutes to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments

relating to our time estimate to this address, not the completed form.”

OMB Number: 0960-0788