The Ticket to Work and Self-Sufficiency Program

Forms and Documents

Document Name	Status
Form SSA-1370 a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370 Form and Instruction	Modified
Form SSA-1365 State Agency Ticket Assignment Form (SSA-1365) Form	Removed
Form SSA-1401 f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form	Modified
Form SSA-1394 i) 20 CFR 411.320 - SSA-1374, EN Contract Changes Form and Instruction	Modified
Form SSA-1391 f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398 Form and Instruction	Modified
Form SSA-1375 c) 20 CFR 411.200(b) - SSA-1375 Form	Modified
Addendum 0644.docx Supplementary Document	2022-02-28
Supporting Statement - 0644 (Final).docx Supporting Statement A	2022-02-28

IC Document Collections

IC ID	Document Title	Status
9680	a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370 Form and Instruction	Modified
251498	j) 20 CFR 411.200(b) - WISE Webinar Survey Other-Wise Survey	New
251497	g) 20 CFR 411.325 (f)- Annual Performance Other-Annual Performance Outcome Report	New
251496	g) 20 CFR 411.325 (f)- Certification of Services	New
218037	Ticket Portal Other-TTW Portal Screens	Removed
218036	State Agency Ticket Assignment Form (SSA-1365) Form	Removed
208203	j) 20 CFR 411.200(b) WISE Webinar Registration Page Other-online registration form	Modified
203490	i) 20 CFR 411.320 - EN Contract Changes, Portal Other-Internet Screens	Removed
201989	a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal Other-Internet Screens	Modified
201988	a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone	Modified
201842	f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al)	Removed
201841	c) 20 CFR 411.200(b) - Request for Certification of Work Portal Screens Other-Internet Screens	Removed
201838	b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens Other-screens	Removed
201837	a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 State Agency Ticket Assignment Form Other-screens	Modified
190323	f) 20 CFR 411.560 - SSA-1401, Split Payment Situations Form	Modified
190204	i) 20 CFR 411.320 - SSA-1374, EN Contract Changes Form and Instruction	Modified
184464	h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions	Modified
184463	g) 20 CFR 411.325(f) - Proof of Relationship Instruction	Modified
184462	f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398 Form and Instruction	Modified
184461	e) 20 CFR 411.400-411.420, 411.325(d), 411.415 - Reporting Referral Agreement	Modified
184460	d) 20 CFR 411.505 - Selecting a Payment System	Modified
184459	c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress	Removed
184457	c) 20 CFR 411.200(b) - SSA-1375 Form	Modified
184456	c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status	Removed
184450	b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures	Modified
184449	b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments Other-screens	Modified
184447	a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing Other-screens	Modified

ICR Details

OMB Control No: 0960-0644	ICR Reference No: 202110-0960-005
Status: Received in OIRA	Previous ICR Reference No: 202101-0960-002
Agency/Subagency: SSA	Agency Tracking No:
Title: The Ticket to Work and Self-Sufficiency Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/28/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2022
Responses	286,183	359,406
Time Burden (Hours)	60,810	84,440
Cost Burden (Dollars)	0	0

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Abstract: SSA’s Ticket to Work (TTW) Program transitions Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients toward independence by allowing them to receive Social Security payments while maintaining employment under the auspices of the program. SSA uses service providers, called Employment Networks (ENs), to supervise participant progress through the stages of TTW Program participation, such as job searches and interviews; progress reviews; and changes in ticket status. ENs can be private for-profit and nonprofit organizations, as well as state vocational rehabilitation agencies (VRs). SSA and the ENs utilize the TTW program manager to operate the TTW Program and exchange information about participants. For example, the ENs use the program manager to provide updates on tasks such as selecting a payment system, or requesting payments for helping the beneficiary achieve certain work goals. Since the ENs are not PRA-exempt, the multiple information collections within the TTW program manager require OMB approval. Most of the categories of information are necessary for SSA to: (1) comply with the Ticket to Work legislation; and (2) provide proper oversight of the program. SSA collects this information through several modalities, including forms, electronic exchanges, and written documentation. The respondents are the ENs or state VRs, SSDI beneficiaries, and blind or disabled SSI recipients working under the auspices of the TTW Program.

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Authorizing Statute(s): US Code: 42 USC 1320b¿19 Name of Law: Social Security Act
   US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 68034	11/30/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 699	02/07/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 19

IC Title	Form No.	Form Name
State Agency Ticket Assignment Form (SSA-1365)	SSA-1365	State Agency Ticket Assignment Form
Ticket Portal
a) 20 CFR 411.140(d)(2) - Ticket Assignability - IVR Automated Telephone
a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a) - SSA-1365 State Agency Ticket Assignment Form
a) 20 CFR 411.140(d)(3); 411.150(b)(3); 411.325(a); 411.465- Individualized Work Plan - SSA-1370	SSA-1370	Ticket to Work Individual Work Plan
a) 20 CFR 411.166; 411.170(b) - Elecronic Data Sharing
b) 20 CFR 411.145 & 411.325 - Requesting Ticket Unassignments
b) 20 CFR 411.145; 411.325 - Unassignments Portal Screens
b) 20 CFR 411.535(a)(1)(iii) - VR Case Closures
c) 20 CFR 411.192(b)&(c) - Request to Place Ticket in Inactive Status
c) 20 CFR 411.200(b) - Request for Certification of Work Portal Screens
c) 20 CFR 411.200(b) - SSA-1375	SSA-1375	Ticket to Work Progress Review Form
c) 20 CFR 411.210(b) -Ticket-Use Status after Not Making Timely Progress
d) 20 CFR 411.505 - Selecting a Payment System
e) 20 CFR 411.400-411.420, 411.325(d), 411.415 - Reporting Referral Agreement
f) 20 CFR 411.560 - SSA-1401, Split Payment Situations	SSA-1401	Employment Network Split Payment Request Form
f) 20 CFR 411.575 - Portal Screens (SSA-1391 et al)
f) 20 CFR 411.575 - Requesting EN Payments - SSA-1391; SSA-1398	SSA-1391, SSA-1389	Employment Network Payment Request Form ,   EN Services Certification Statement (For Use with Phase 1 Milestone 4 Request)
g) 20 CFR 411.325 (f)- Annual Performance
g) 20 CFR 411.325 (f)- Certification of Services
g) 20 CFR 411.325(f) - Proof of Relationship
h) 20 CFR 411.435, 411.615, 411.625 - Dispute Resolutions
i) 20 CFR 411.320 - EN Contract Changes, Portal
i) 20 CFR 411.320 - SSA-1374, EN Contract Changes	SSA-1394	Employment Network Contract Change Form
j) 20 CFR 411.200(b) - WISE Webinar Survey
j) 20 CFR 411.200(b) WISE Webinar Registration Page

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	286,183	359,406	0	4,721	-77,944	0
Annual Time Burden (Hours)	60,810	84,440	0	789	-24,419	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: When we last cleared this IC in 2019, the burden was 84,440 hours. However, we are currently reporting a burden of 60,810 hours. This decrease stems the agency reducing some data collections and increasing automation through the portal. These figures represent current Management Information data

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Annual Cost to Federal Government: $7,220,264

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/28/2022

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