WIPA Provider Survey

Attachment A2a: Ticket Act Provider Survey for WIPA Projects: Invitation Letter Packet (Week 1)

OMB Control #: XXXX-XXXX;

Expiration Date: 06/30/20xx

J anuary xx, 2026

WIPA Project Director

[FILL Organization Name]

[FILL Organization Street Address]

[FILL City, State, Zip]

Dear Ticket Act Service Provider:

On behalf of the Social Security Administration (SSA), I am inviting you to take part in the Ticket Act Provider Survey for Work Incentives Planning and Assistance (WIPA) Projects. This national survey is part of an evaluation SSA is conducting about Ticket to Work and Work Incentives Improvement Act programs. SSA has hired Mathematica, an independent research firm, to carry out the evaluation and to field this survey.

Why this matters. Survey results will help SSA gain insights about the experiences of WIPA projects in providing Ticket Act program services, the extent to which Ticket Act services meet Supplemental Security Income and Social Security Disability Insurance beneficiaries’ needs, features of Ticket Act programs that work well, and areas for improvement.

About the survey. We are asking you to take part in this voluntary survey, responding on behalf of your WIPA project. The survey takes about 38 minutes to complete, including time spent looking up information or consulting with others, as needed. Mathematica will send you a $40 check for completing the survey.

To begin the survey:

Go to: [FILL personalized URL]

or

Scan this QR Code:

Taking part in this survey is voluntary. You may skip any questions you do not want to answer. To protect your privacy, Mathematica will not share your answers in any way that reveals who you are unless required to do so by Federal laws, regulations, and directives.

More information is available. Enclosed is the survey consent statement and a summary of the topics covered in the survey. SSA has an informational website on the evaluation overall. To learn more, go to https://www.ssa.gov/disabilityresearch/ticketevaluation.html.

Thank you for your WIPA project’s efforts providing Ticket Act services. We look forward to learning more about your experiences through this survey. If you have any questions, please call Holly Matulewicz, the Survey Director at Mathematica, at XXX-XXX-XXX.

Sincerely,

---insert signature image here---

Susan Wilschke

Associate Commissioner

Office of Research, Demonstration, and Employment Support

Social Security Administration

Privacy Act Statement

Section 1110(a) of the Social Security Act, as amended, allows us to collect this information, which we will use to conduct research and improve SSA programs. Providing us this information is voluntary; not providing all or part of the information will not affect you. As law permits, we may use and share the information you submit, including with other Federal agencies, contractors, and others, as outlined in the routine uses within System of Records Notice (SORN) 60-0218, available at www.ssa.gov/privacy. The information you submit may also be used in computer matching programs for Federal benefits eligibility and to recoup debts under these programs.

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995, nobody is required to respond to a collection of information unless it displays a valid OMB control number. The valid Office of Management and Budget (OMB) control number for this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 38 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

C

onsent statement for Ticket to Work Evaluation provider survey

What is the Ticket to Work Evaluation and who is conducting it?

The Social Security Administration (SSA) is conducting an evaluation of the Ticket to Work (TTW) programs offered by: Employment Networks (ENs) (including Vocational Rehabilitation (VR) agencies), Work Incentives Planning and Assistance (WIPA), and Protection & Advocacy for Beneficiaries of Social Security (PABSS). SSA hired Mathematica, a national research company, to conduct the evaluation.

Why are we conducting a survey?

We developed surveys for EN/VR, PABSS, and WIPA providers. The survey will ask people delivering EN/VR, PABSS, and WIPA services about their experiences implementing their program, the extent to which they believe it meets beneficiaries’ needs, and the parts of the program that work well and where there are areas for improvement.

What do you want me to do?

We ask for your consent to participate in a voluntary one-time, 38-minute web-based survey conducted by Mathematica. By consenting to participate, you are agreeing to SSA maintaining any responses that you provide in the survey. You do not have to answer any questions you do not want to and can stop at any time. We will use what we learn as part of our evaluation of Ticket to Work programs, as Federal law, regulations, and directives permit.

How was I selected for this survey?

SSA provided Mathematica a list of EN/VR, WIPA, and PABSS providers to contact to complete the survey.

Do I have to complete the survey?

Your participation in this survey is voluntary. It is being conducted for research purposes. If you decide not to take part, it will not affect any future decision SSA makes about funding services noted above.

How will you protect my privacy?

We will follow Federal law and regulations to protect your privacy. SSA and Mathematica will protect your personal information during the survey consistent with Federal law, regulations, and directives. Information shared with the Social Security Administration for this research will be used for limited purposes consistent with applicable Federal law, regulations, and directives. For example, we use your survey responses, combined with survey responses from others, as part of our evaluation of Ticket to Work programs. No information provided for this research study will be used to determine future decisions about funding or to audit individual providers.

What are the benefits?

You will not benefit directly from participation. But you may help SSA to understand the experiences and challenges of people managing its programs. This information may help SSA improve their programs.

Will I receive any money for participating?

After completing the survey, we will mail you a $40 check.

What are the risks?

There are no known risks to participating in the survey.

For more information

For more information about the Ticket to Work evaluation, please go to https://www.ssa.gov/disabilityresearch/ticketevaluation.html. Please contact Mathematica at 1-xxx-xxx-xxxx if you have any questions about the survey. The project director is Denise Hoffman and the survey director is Holly Matulewicz. For questions about your rights and welfare as a research participant, you may contact the Health Media Lab Institutional Review Board at 1-202-246-8504. The Health Media Lab Institutional Review Board is responsible for overseeing the protection of your rights and welfare as a research participant in this study.

OMB Control #: XXXX-XXXX;

Expiration Date: 06/30/20xx

Topics in the Ticket Act Provider Survey for Work Incentives Planning and Assistance (WIPA) Projects

Below is a list of topics covered in the Ticket Act Provider Survey for Work Incentives Planning and Assistance (WIPA) projects.

We provide this list to help you determine whether you would like to have records accessible or consult with others in your organization to complete the survey. Not all topics will be asked of all organizations that complete the survey.

Survey topics for WIPA projects
Organizational characteristics
Organization type and years of operation Whether organization is also an EN or PABSS agency Funding from SSA and other sources Partnerships with other organizations	Organization staffing Average caseloads for CWICs and the share of clients served under WIPA funding Outreach to SSI and SSDI beneficiaries and the availability of materials in alternate formats or languages
Beginning to work with beneficiaries
Experiences with referrals from TTW helpline Common concerns among beneficiaries seeking services Share of clients working with an EN	Beneficiary referrals Waitlist for services (including waitlist size and average time on waitlist) Wait time for BPQY
Providing services to beneficiaries
Services provided to beneficiaries (such as individualized benefits counseling) Share of CWIC time spent on services and other tasks	Use of remote and in-person services Current staffing capacity Service delivery challenges
Reflections on the WIPA program
Effectiveness of WIPA services for different groups of beneficiaries	Recommendations for program improvements

BPQY = Benefits Planning Queries; CWICs = Certified Work Incentive Coordinator; EN= Employment Network; PABSS = Protection & Advocacy for Beneficiaries of Social Security; SSA = Social Security Administration; TTW = Ticket to Work; WIPA = Work Incentives Planning and Assistance; SSI = Supplemental Security Income (Title XVI); SSDI = Social Security Disability Insurance (Title II)

Have questions?

If you have any questions about the survey or need help, please contact Mathematica, the research firm conducting the survey for the Social Security Administration, at xxx-xxx-xxxx.