PABSS Provider Survey

Attachment A3d: Ticket Act Provider Survey for P&A Agencies Receiving PABSS Funding: Reminder Email (Week 4.5)

OMB Control #: XXXX-XXXX;

Expiration Date: 06/30/20xx

To: [FILL organizational contact email address]

S
ubject: Ticket Act service provider: your P&A agency’s experiences matter!

Dear Ticket Act Service Provider:

As an organization receiving Protection and Advocacy for Beneficiaries of Social Security (PABSS) funding to deliver Ticket Act services, you have an important perspective on 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 the Ticket Act programs that work well, and areas for improvement.

We have invited your PABSS organization to take part in the Ticket Act Provider Survey for Protection and Advocacy (P&A) Agencies receiving Protection and Advocacy for Beneficiaries of Social Security (PABSS) Funding but have not yet heard from you. This national survey is part of an evaluation the Social Security Administration (SSA) is conducting about Ticket to Work and Work Incentives Improvement Act programs. SSA hired Mathematica, an independent research firm, to carry out the evaluation and to field this survey.

About the survey. We are asking you to take part in this voluntary survey, responding on behalf of your P&A agency. The survey takes about 28 minutes to complete, including time spent gathering information or consulting with others, as needed.

To begin the survey:

Go to: [FILL personalized URL]

or

Scan this QR Code:

Mathematica will send you $40 for completing the survey.

Taking part 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.

Have questions or need help? If you have questions, or if someone else at your P&A agency should complete the survey, please call me at XXX-XXX-XXX.

Sincerely,

Holly Matulewicz

Survey Director at Mathematica

Please note that this email mailbox is not a secure means of communication with us. It is possible that information you include in an email can be intercepted by others outside of our organization and used by those third parties for purposes you did not intend. For this reason, if you choose to communicate via email, please limit personal information about yourself and include only the minimal information that is necessary to convey your question. Please do not send any personal information such as full name, date of birth, or Social Security number via email.

Privacy Notice: Confirmit (Forsta) is a nongovernment application that may have different privacy policies from those of the SSA. This application is not under SSA’s control and may not follow SSA’s privacy, security, or accessibility policies located on their official website at https://www.ssa.gov/privacy. Once you access this application, you are subject to Confirmit’s (Forsta) policies. As such, by using this application, you may be providing non-government third parties access to your personally identifiable information (PII). Mathematica is taking precautions to protect your privacy and PII, such as by using secure equipment and limiting access to your information. To minimize any risk of access by unauthorized third parties, we recommend that you use a reliable, secured, and private internet connection and complete the survey in a private location. General information about SSA programs may be found at http://www.ssa.gov/.