Information Collection Request

Site Review Questionnaires for Volume and Fee-for-Service Payees and Beneficiary Interview Form

ICR 200702-0960-001 · OMB 0960-0633 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SSA-637--revised Site Review Questionnaires for Volume and Fee-for-Service Payees Form Modified Available
Form SSA-639 (revised) Expanded Monitoring Site Review: Beneficiary Interview Form Form New Available
Supporting Statement--0633.doc Supporting Statement A Uploaded 0000-00-00 Available
SSA639.doc Supplementary Document Uploaded 2003-10-31 Available
SSA-637.pdf Supplementary Document Uploaded 2005-05-31 Available
Addendum--0633.doc Supplementary Document Uploaded 2007-02-02 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
38057 Site Review Questionnaires for Volume and Fee-for-Service Payees Form Modified
178591 Expanded Monitoring Site Review: Beneficiary Interview Form Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2010 36 Months From Approved 06/30/2007
9,488 0 7,860
4,784 0 2,426
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,488 7,860 0 1,628 0 0
Annual Time Burden (Hours) 4,784 2,426 0 2,358 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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