| Social Security Adminstration |
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Form Approved OMB No. 0960-0421 |
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| TIME REPORT OF PERSONNEL SERVICES FOR DISABILITY DETERMINATION SERVICES |
| (See instructions for completing form on reverse) |
| NAME OF AGENCY |
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STATE |
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QUARTER ENDING |
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| Do not include non-Federal hours, compensatory time worked, or compensatory leave used in any category of this report. |
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(A) |
(B) |
(C) |
(D) |
(E) |
(F) |
| POSITION CATEGORIES |
On Duty Hours |
Holiday and |
Total Hours |
Overtime |
Total |
Total |
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(Excluding OT) |
Leave Hours |
(Excluding OT) |
Hours |
Hours |
FTEs |
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(Col A+B) |
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(Col C+D) |
(**Calc) |
| 1. |
Total Full-Time Personnel |
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(Sum of lines 1a through 1k) |
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0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
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a. |
Administrative Personnel |
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0.00 |
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0.00 |
0.00 |
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b. |
Supervisors |
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0.00 |
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0.00 |
0.00 |
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c. |
Examiners |
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0.00 |
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0.00 |
0.00 |
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d. |
Trainee Examiners |
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0.00 |
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0.00 |
0.00 |
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e. |
Hearing Officers |
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0.00 |
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0.00 |
0.00 |
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f. |
Clericals |
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0.00 |
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0.00 |
0.00 |
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g. |
Case Consultants |
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0.00 |
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0.00 |
0.00 |
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h. |
Medical Consultants |
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0.00 |
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0.00 |
0.00 |
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i. |
QA Personnel |
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0.00 |
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0.00 |
0.00 |
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j. |
Vocational Specialists |
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0.00 |
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0.00 |
0.00 |
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k. |
Systems Specialists |
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0.00 |
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0.00 |
0.00 |
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l. |
All Others |
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0.00 |
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0.00 |
0.00 |
| 2. |
Total Part-Time Personnel |
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(Sum of lines 2a through 2k) |
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0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
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a. |
Administrative Personnel |
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0.00 |
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0.00 |
0.00 |
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b. |
Supervisors |
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0.00 |
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0.00 |
0.00 |
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c. |
Examiners |
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0.00 |
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0.00 |
0.00 |
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d. |
Trainee Examiners |
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0.00 |
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0.00 |
0.00 |
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e. |
Hearing Officers |
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0.00 |
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0.00 |
0.00 |
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f. |
Clericals |
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0.00 |
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0.00 |
0.00 |
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g. |
Case Consultants |
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0.00 |
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0.00 |
0.00 |
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h. |
Medical Consultants |
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0.00 |
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0.00 |
0.00 |
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i. |
QA Personnel |
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0.00 |
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0.00 |
0.00 |
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j. |
Vocational Specialists |
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0.00 |
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0.00 |
0.00 |
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k. |
Systems Specialists |
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0.00 |
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0.00 |
0.00 |
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l. |
All Others |
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0.00 |
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0.00 |
0.00 |
| 3. |
Total Temporary Personnel |
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(Sum of lines 3a and 3b) |
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0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
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a. |
Full-Time |
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0.00 |
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0.00 |
0.00 |
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b. |
Part-Time |
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0.00 |
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0.00 |
0.00 |
| 4. |
Total Direct Personnel Services |
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(Sum of lines 1, 2, and 3) |
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0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
| 5. |
Total FTE (**calculation) |
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0.00 |
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0.00 |
0.00 |
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0.00 |
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| REMARKS: |
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| **Total FTEs are computed using 520 hours for regular time (column C) and 438.75 hours for overtime (column D). |
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| Signature |
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Title |
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Date |
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| Form SSA-4514 (6-2001) |
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| Destroy All Prior Editions |
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