Information Collection

Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries

IC 238019 under ICR 201908-0960-001 · OMB 0960-0629.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0629 can be found here:

Documents and Forms

Document Name Document Type
Form SSA-4565 Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries Form
SSA-4565 WIPA Intake Information SSA 4565 Mockup.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-4565	WIPA Intake Information	SSA 4565 Mockup.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	12,500	12,500
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.