Justification for Non-Substantive Changes to 0960-0644

Justification for Non-Substantive Changes for (SSA-1375)

Progress Review Form

CFR Citations 411.180-411.226

OMB No. 0960-0644

Justification for Non-Substantive Changes to the SSA-1375:

• Change #1: We are revising the sign, date and return language on page 1 under Instructions:

Old Language:

Then sign, date, and return this form to MAXIMUS using the enclosed postage paid envelope or by fax at 703-683-3289.

New Language:

Then sign, date, and return this form to Ticket To Work using the enclosed postage paid envelope or by fax at 703-683-3289.

Justification #1: We are revising the language, because the Ticket to Work program no longer contracts with MAXIMUS. Therefore, we are changing the reference to the program name, “Ticket to Work.”

• Change #2: We are revising the Trial Work Level earnings amount on page 1, First 12-Month Progress Review Requirements Section A:

Old Language:

1. I worked 3 out of 12 months with earnings at or above $940 in each month (Trial Work Level for 2021).

New Language:

1. I worked 3 out of 12 months with earnings at or above $1,050 in each month (Trial Work Level for 2023).

Justification #2: We are updating the Trial Work Period amount to reflect the annual 2023 amount (the current version shows the amount for 2021).

SSA will implement these changes upon OMB approval. These revisions will not affect the current burden for this information collection.

Resubmission of the Collection within One Year of OMB Approval:

We are revising the collection within a year of the OMB approval date, because we submitted the clearance package in August 2021, but only just received approval in November 2023. Since we submitted this package for clearance, the agency has changed contractors and increased the amount of Trial Work Level. We would like to update this form to ensure that we are providing accurate information to the beneficiaries who SSA requires to fill out the form to determine whether they should retain their Medical CDR protection.