Forms

Current Employment Networks (EN) and State Vocational Rehabilitation (VR) agencies must submit various forms to the Social Security Administration and the Ticket Program Manager. For questions about a specific form, use the contact information located on the form.

Maintenance

  • Form 1374: Ticket Program Agreement (TPA) Change Form (PDF)
  • Form 222: Security Awareness - Contractor Personnel Security Certification (PDF)
  • Form 222: Security Awareness Addendum - Contractor Personnel Security Certification (PDF) Updated!
  • Ticket Program Agreement (TPA) Termination Form (PDF)
  • Work From Home Request Form (PDF)
  • Work From Home Request Addendum (PDF)
  • Benefits Counseling Certification Addendum (PDF) 

Suitability

  • Electronic Application Applicant Listing (XLS)
  • Contractor Personnel Rollover Request Form (PDF)
  • Fingerprint Scheduling Instructions (PDF)
  • I-9 Approved Documents (PDF)
  • Standard Form 85 (PDF)
  • Declaration for Federal Employment OF-306 (PDF) Updated!

Services and Supports

  • Form 1370: Individual Work Plan (PDF) Updated!

Payments

  • Proof of Relationship (PoR) Form (PDF) New!
  • Form 1373: EN Supplemental Earnings Statement (PDF)
  • Form 1391: EN Payment Request Form (PDF)
  • Form 1401: EN Split Payment Request Form (PDF)
  • EN Certification of Services (COS) Statement (PDF)
  • Employer-Prepared Earnings Statement (PDF)