National Beneficiary Survey -- National Beneficiary Sample

Ticket to Work Program Evaluation Survey (National Beneficiary Survey)

Documents and Forms

Document Name Document Type
Advance Letter.doc No response required; just needs to be read by participant Other-Advance Letter to Participants
Proxy Screener.doc Note: Participant does not need to complete; read by contractor Other-Pre-Survey Screener
National Beneficiary Survey (parts used for ticket participant sample as well).doc Note: Participant does not need to complete; read by contractor Other-Survey Script

Information Collection (IC) Details

IC Title:	National Beneficiary Survey -- National Beneficiary Sample	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Electronic Capability
Other-Advance Letter to Participants	Advance Letter.doc	No response required; just needs to be read by participant	No	Paper Only
Other-Pre-Survey Screener	Proxy Screener.doc	Note: Participant does not need to complete; read by contractor	No	Paper Only
Other-Survey Script	National Beneficiary Survey (parts used for ticket participant sample as well).doc	Note: Participant does not need to complete; read by contractor	No	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	1,800	1,800
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.