Survey 1 Competency Screening

SSA Work Disability Functional Assessment Battery (WD-FAB) Data Collection

Documents and Forms

Document Name Document Type
Attachment A1. Survey 1 and 2 Classification Questions.pdf Other-Survey 1 and 2 Classification
Attachment A9. Survey 1 Screener and Callback Script.pdf Other-Screener and Callback Script
Attachment A13. Survey 2 Screener and Callback Script.pdf Other-Screener and Callback Script

Information Collection (IC) Details

IC Title:	Survey 1 Competency Screening	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey 1 and 2 Classification Questions	Attachment A1. Survey 1 and 2 Classification Questions.pdf	Yes	Yes	Fillable Fileable
Other-Screener and Callback Script	Attachment A9. Survey 1 Screener and Callback Script.pdf	Yes	No	Paper Only
Other-Screener and Callback Script	Attachment A13. Survey 2 Screener and Callback Script.pdf	Yes	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,500	4,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	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.