Forms Catalog Document - SSA1365 :-: SSA :-: State Agency Ticket Assignment Form

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State Agency Ticket Assignment Form

State Agency Ticket Assignment Form - The Social Security Administration (SSA) needs the information collected on Form SSA-1365 to determine proper assignment of Tickets under the program and to monitor services provided by Employment Networks. Public Law 106-107 requires both of these functions of SSA. The information collected on the SSA-1365 will be used by SSA contracted Program Manager (PM) to perform the task of assigning beneficiaries' tickets and monitoring the use of tickets under this new legislation. The State VR agency answers the questions and the beneficiary reviews the data and if in agreement with it sign their Ticket to that agency. The SSA-1365 will be completed each time a Ticket is assigned to an SSA beneficiary.

Form #: SSA 1365
Agency: Social Security Administration

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Both Form and Instructions	2		[2] Printable Only	Adobe Reader Download

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