OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565)

IC 238019 under ICR 202203-0960-011 · OMB 0960-0629.

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565)
 
No Modified
 
Voluntary
 

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 (revised).pdf No   Paper Only
Form SSA-4566 WIPA CASE NOTES SSA-4566 (revised).pdf Yes Yes Fillable Printable

Income Security General Retirement and Disability

 

32,000 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 32,000 0 2,000 0 0 30,000
Annual IC Time Burden (Hours) 13,333 0 833 0 0 12,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Work Incentives Planning and Assistance Program (WIPA)-- SSI & SSI Beneficiaries (SSA-4565) SSA-4565 (current).pdf 05/25/2022
WIPA CASE NOTES (SSA-4566) SSA-4566 (current).pdf 05/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.