Supporting Statement for Form SSA-4290-F5
Development of Participation in a
Vocational Rehabilitation or Similar Program
20 CFR 404.316(c), 404.337(c), 404.352(d), 404.1586(g), 404.1596, 404.1597(a), 404.327, 404.328, 416.1321(d), 416.1331(a)-(b), and 416.1338, 416.1402
OMB No. 0960-0282
A. Justification
Introduction/Authoring Laws and Regulations
The Ticket to Work and Self-Sufficiency Program allows recipients of Title II benefits and Title XVI Social Security Administration (SSA) disability payments to continue receiving payments while enrolled in a vocational rehabilitation, or other job-training program. Sections 404.316(c), 404.327, 404.328, 404.337(c), 404.352(d), 404.1586(g), 404.1596, 404.1597(a), 416.1321(d), 416.1331(a)-(b), and 416.1338 of the Code of Federal Regulations implement the provision that, provided they are still enrolled in a vocational rehabilitation or other job-training program, disability recipients may continue to receive benefits even if their disability ceases. These sections require proof of the disability recipient’s enrollment in a vocational rehabilitation or job-training program. We use Form SSA-4290-F5, the Development of Participation in a Vocational Rehabilitation (VR) or Similar Program, for that purpose. Sections 225(b)(2) and 1631(a)(6) of the Social Security Act (Act) provide the statutory authority for use of this form. Regulatory authority for use of this form stems from 20 CFR 404.316, 404.337, and 404.352; 404.1586, 404.1596, and 404.1597; 416.1321, 416.1331, and 416.1338; and 416.1402 of the Code of Federal Regulations.
Description of Collection
State Disability Determination Services (DDS) determine if Social Security disability payment recipients whose disability ceased, and who participate in vocational rehabilitation programs may continue to receive disability payments. To do this, DDS need information about the recipients; the types of program participation; and the services they receive under the rehabilitation program. SSA uses Form SSA-4290-F5 to collect this information. The respondents are State employment networks, vocational rehabilitation agencies, or other providers of educational or job training services.
Use of Information Technology to Collect the Information
SSA contacts the responded by pone to complete Form SSA-4290, If we are unable to reach the respondent by phone, SSA mails Form SSA-4290-F5 to the respondent to mail bac to SSA. SSA did not create an electronic version of form SSA-4290-F5 under the agency’s Government Paperwork Elimination Act (GPEA) plan because only 3,000 respondents complete the form annually. Given the low volume of respondents for this form, and the agency’s limited resources, we are unable to schedule it for electronic implementation at this time.
Why We Cannot Use duplicate Information
The nature of the information we collect and the manner in which we collect it preclude duplication. SSA does not use another collection instrument to obtain similar data.
Minimizing Burden on Small Respondents
This collection does not affect small businesses or other small entities.
Consequence of Not Collecting Information or Collecting it Less Frequently
If we did uses Form SSA-4290-F5, State DDSs would be unable to determine if disability recipients whose disability ceased but who wanted to continue participating in an Employment Network, or VR program should still receive Title II benefits or Title XVI payments. Because we only collect the information on an as needed basis, we cannot collect it less frequently. There are no technical or legal obstacles to burden reduction.
Special Circumstances
There are no special circumstances that would cause SSA to conduct this information collection in a manner inconsistent with 5 CFR 1320.5.
Solicitation of Public Comment and Other Consultations with the Public
The 60-day advance Federal Register Notice published on February 5, 2020, at
85 FR 6671, and we received no public comments. The 30-day FRN published on April 7, 2020 at 85 FR 19563. If we receive any comments in response to this Notice, we will forward them to OMB. We did not consult with the public in the maintenance of this form.
Payment or Gifts to Respondents.
SSA does not provide payment or gifts to the respondents.
Assurance of Confidentiality
SSA protects and holds confidential the information it collects in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.
Justification for Sensitive Questions
The information collection does not contain any questions of a sensitive nature.
Modality of Completion |
Number of Respondents |
Frequency of Response |
Average Burden per Response (minutes) |
Estimated Total Annual Burden (hours) |
Average Theoretical Hourly Cost Amount (dollars)* |
Average Wait Time in Field Office (minutes)*** |
Total Annual Opportunity Cost (dollars)** |
SSA-4290-F5 |
3,000 |
1 |
15 |
750 |
$17.22* |
27 |
$12,915** |
Estimates of Public Reporting Burden
*We based this figure on average Social and Human Service Assistant’s hourly salary, as reported by Bureau of Labor Statistics data.
**This figure does not represent actual costs that SSA is imposing on recipients of Social Security payments to complete this application; rather, these are theoretical opportunity costs for the additional time respondents will spend to complete the application. There is no actual charge to respondents to complete the application.
The total burden for this ICR is 750 hours burden hours (reflecting SSA management information data), which results in an associated theoretical (not actual) opportunity cost financial burden of $12,915.00. SSA does not charge respondents to complete our applications.
Annual Cost to the Respondents
This collection does not impose a known cost burden to the respondents.
Annual Cost to Federal Government
The annual cost to the Federal Government is approximately $28,550. This estimate accounts for costs from the following areas: (1) designing, printing, and distributing the form; and (2) SSA employee (e.g., field office, program service center staff) information collection and processing time.
Program changes or Adjustments to the Information Collection Request
There are no changes to the public reporting burden.
Plans for Publication Information Collection Results
SSA will not publish results of the information collection.
Displaying the OMB Approval Expiration Date
OMB granted SSA an exemption from the requirement to print the OMB expiration date on its program forms. SSA produces millions of public-use forms, with life cycles exceeding those of an OMB approval. Since SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis), OMB granted this exemption so SSA would not have to destroy stocks of otherwise useable forms with expired OMB approval dates avoiding Government waste.
Exceptions to Certification Statement
SSA is not requesting an exception to the certification requirements at
5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).
B. Collections of Information Employing Statistical Methods
SSA does not use statistical methods for this information collection.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | SUPPORTING STATEMENT FOR FORM SSA-4290 VOCATIONAL REHABILITATION "301" PROGRAM DEVELOPMENT |
| Author | LDAVID |
| File Modified | 0000-00-00 |
| File Created | 2021-01-16 |