Tuesday, August 1, 2017
1:00 p.m. to 3:00 p.m. EDT

National Education Association
Chanin Auditorium (Level B3)
1201 16th Street, NW
Washington, DC 20036

* 2. First name

* 3. MI

* 4. Last name

* 6. Phone number

* 7. Email address

* 8. Name of your organization

* 10. Job title

* 11. How will you participate?

* 12. Are you an employee of the Social Security Administration (SSA)?

* 13. Do you require special accommodation?

* 15. Twitter handle

Paperwork Reduction Act Statement – This information collection meets the requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995.  You do not need to answer these questions (OR participate in this focus group OR complete this telephone survey) unless we display a valid Office of Management and Budget control number.  We estimate that it will take about 2 minutes to read the instructions, gather the facts, and answer the questions.  You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD  21235-6401.  Send only comments relating to our time estimate to this address, not the completed form.”
OMB Number: 0960-0788

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