Common Contracts

Ticket Program Agreement (TPA) Termination Form

Program Agreement • January 15th, 2018

• Contract Type
  Program Agreement
• Filed
  January 15th, 2018

Use this form to request termination of your TPA and unassign all assigned Tickets. This form should be submitted by the Signatory Authority directly to the Employment Network Service Team (ENST). ENST can be reached by email at ENService@ssa.gov or by fax at 410.597.0429. All fields below must be filled out.