Survey 1 (respondents)

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

Documents and Forms

Document Name Document Type
Attachment A2. Survey 1 and 2 VR-12.pdf Other-Survey 1 VR-12
Attachment A3. Survey 1 and 2 WD-FAB items.pdf Other-WD-FAB Items
Attachment A4. Survey 1 Follow-up Questions.pdf Other-Follow-up Questions
Attachment A5. Survey 2 Follow-up Questions.pdf Other-Survey 2 Follow-up Questions
Attachment A6. Study Invitation Letter.pdf Other-Study Invitation Letter
Attachment A7. Research Consent Form.pdf Other-Research Consent Form
Attachment A8. Study App Download Instructions.pdf Other-Study App Download Instruction
Attachment A10. Text Message Reminders.pdf Other-Text Message Reminders
Attachment A11. Survey 1 and 2 Initial Emails.pdf Other-Inital Emails
Attachment A12. Survey 1 and 2 Reminder Emails.pdf Other-Reminder Emails
Attachment A14. Study App Push Notifications.pdf Other-Study App Push Notification

Information Collection (IC) Details

IC Title:	Survey 1 (respondents)	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 VR-12	Attachment A2. Survey 1 and 2 VR-12.pdf	Yes	Yes	Fillable Fileable
Other-WD-FAB Items	Attachment A3. Survey 1 and 2 WD-FAB items.pdf	Yes	Yes	Fillable Fileable
Other-Follow-up Questions	Attachment A4. Survey 1 Follow-up Questions.pdf	Yes	Yes	Fillable Fileable
Other-Survey 2 Follow-up Questions	Attachment A5. Survey 2 Follow-up Questions.pdf	Yes	Yes	Fillable Fileable
Other-Study Invitation Letter	Attachment A6. Study Invitation Letter.pdf	No		Paper Only
Other-Research Consent Form	Attachment A7. Research Consent Form.pdf	Yes	Yes	Fillable Fileable
Other-Study App Download Instructions	Attachment A8. Study App Download Instructions.pdf	Yes	No	Fillable Printable
Other-Text Message Reminders	Attachment A10. Text Message Reminders.pdf	Yes	No	Paper Only
Other-Inital Emails	Attachment A11. Survey 1 and 2 Initial Emails.pdf	Yes	Yes	Fillable Fileable
Other-Reminder Emails	Attachment A12. Survey 1 and 2 Reminder Emails.pdf	Yes	No	Paper Only
Other-Study App Push Notification	Attachment A14. Study App Push Notifications.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: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	3,333	3,333
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.