a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal

The Ticket to Work and Self-Sufficiency Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0644 can be found here:

Documents and Forms

Document Name Document Type
Secure Provider Portal Screens.pdf Other-Internet Screens
Portal Phase II Forms.pdf Other-Internet Screens
DemoDeck.pptx Other-screens

Information Collection (IC) Details

IC Title:	a) 20 CFR 411.140(d)(2) - Ticket Assignability - Portal	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 411.140(d)(2)

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens	Secure Provider Portal Screens.pdf	Yes	Yes	Fillable Fileable Signable
Other-Internet Screens	Portal Phase II Forms.pdf	Yes	Yes	Fillable Fileable Signable
Other-screens	DemoDeck.pptx	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 91,484	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	91,484	65,771	25,713
Annual IC Time Burden (Hours)	3,049	2,513	536
Annual IC Cost Burden (Dollars)	0	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.