Description WIPA Customer Comment Instrument

1. Request for Approval under the “Generic Clearance for the Collection of

2. Routine Customer Feedback” (OMB Control Number: 0960-0788)

TITLE OF INFORMATION COLLECTION: Work Incentive Planning and Assistance (WIPA) Customer Comment Instrument

PURPOSE:

Response - Congress enacted the Ticket to Work and Work Incentives Improvement Act, P.L. 106-170, (the Act) in 1999 to remove many barriers and disincentives to employment for individuals with disabilities, and to provide alternative ways to obtain employment supports and maintain health care coverage. Section 121 of the Act directed the Social Security Administration (Social Security) to establish a community-based benefits planning and assistance program to provide accurate and timely information on work incentives and related issues to Social Security beneficiaries. Social Security established the Work Incentives Planning and Assistance (WIPA) program in response to the legislation.

The WIPA program consists of 83 local projects that cover all 50 states, the District of Columbia, and 5 U.S. territories. The WIPA projects employ over 440 Community Work Incentives Coordinators (CWICs) to deliver work incentives counseling services to beneficiaries through the WIPA projects. WIPA services include development of a detailed summary of a beneficiary’s current benefit status, analysis of the effect of earnings on benefit amount and continued eligibility, information on the potential use of various work incentives, and provision of ongoing support services as the beneficiary’s employment and benefit status change over time.

The WIPA programs serve a combined total of over 30,000 beneficiaries each year. The projects do not have a formal mechanism to allow beneficiaries to comment on the work incentive counseling services provided by the CWICs. The purposes of the WIPA Customer Satisfaction Instrument are to: (1) enable beneficiaries to express their overall satisfaction with WIPA products and services (service delivery, ongoing support, and guidance on employment and work incentives); and (2) assist WIPA projects to obtain useful feedback on the quality and responsiveness of the services they deliver.

DESCRIPTION OF RESPONDENTS:

Response - All respondents will be Social Security disability beneficiaries (SSI, Title II, or SSI/Title II) who have received services from a Social Security funded WIPA program. Respondents will include individuals who received WIPA services beginning November 1, 2017. No retroactive data collection will occur.

Based on data from the past four years, the WIPA projects served a mean of 34,000 beneficiaries per year. Of these individuals, 20,400 (60 percent) receive individualized, intensive work incentives counseling services. The 20,400 beneficiaries will be the universe for the information collection. Each individual within the universe will have the opportunity to respond to the data collection – we will not conduct any sampling.

TYPE OF COLLECTION: (Check one)

[X ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Naomi Sipple, Reports Clearance Team Leader, Social Security Administration

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [ X] No – No PII will be will be collected

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No - NA

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No - NA

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (minutes)	Burden (hours)
Individuals or Households - Social Security disability beneficiaries served by 83 WIPA programs	20,400	7	2,380
Totals	20,400		2,380

(Number of responses (X) estimated response time (/60) = burden hours):

FEDERAL COST: The estimated annual cost to the Federal Government is $2086.00 annually.

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of

Response - We do not have a specific list of beneficiaries who will participate in the information collection. The 83 WIPA projects serve beneficiaries who were referred by the Ticket to Work Help Line, Employment Networks, state Vocational Rehabilitation agencies, and other local service programs. Beneficiaries also are able to self-refer to the WIPA projects.

Approximately, 13,600 individuals (40 percent of all referrals) will receive basic information and referral services. We do not individualize these services to the beneficiary’s personal situation and usually require less than five minutes of contact with the individual. These beneficiaries will not be included in the data collection.

A total of 20,400 beneficiaries per year will receive individualized WIPA services. These services include verification of current benefits, development of a complete and accurate employment history, description of the effect of earnings on cash benefits and health care coverage, and potential use of various work incentives. These individuals, who have received more intensive services for a longer period of time, will participated in completing the satisfaction form.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[X] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

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