Work Incentive Planning and Assistance (WIPA) Customer Comment Instrument

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Fast Track)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0788 can be found here:

Documents and Forms

Document Name Document Type
WIPA Customer Satisfaction Instrument Sample.docx Other-WIPA Sample
Description of WIPA Customer Satisfaction Instrument.docx Description WIPA Customer Comment Instrument IC Document

Information Collection (IC) Details

IC Title:	Work Incentive Planning and Assistance (WIPA) Customer Comment Instrument	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WIPA Sample			WIPA Customer Satisfaction Instrument Sample.docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,400	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
Annual Number of Responses for this IC	20,400	20,400
Annual IC Time Burden (Hours)	2,380	2,380
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Description WIPA Customer Comment Instrument	Description of WIPA Customer Satisfaction Instrument.docx	11/21/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.