Beneficiary Interview and Auditor's Observations

Forms and Documents

Document Name	Status
Form SSA-322 Beneficiary Interview and Auditor's Observations Form	Modified
Memo August 14 2007.pdf Supplementary Document	2007-08-14
Supporting Statement- SSA-322 8-14-2007.doc Supporting Statement A	2007-08-14

IC Document Collections

IC ID	Document Title	Status
9653	Beneficiary Interview and Auditor's Observations Form	Modified

ICR Details

OMB Control No: 0960-0630	ICR Reference No: 200702-0960-003
Status: Historical Active	Previous ICR Reference No: 200405-0960-001
Agency/Subagency: SSA	Agency Tracking No:
Title: Beneficiary Interview and Auditor's Observations
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/16/2007
	Date Received in OIRA: 05/21/2007
Terms of Clearance: This ICR is approved consistent with the memo of August 14, 2007 and on the understanding that roughly 95% of the interviewees are beneficiaries themselves, not their rep payees. SSA agrees to add a check box to the IC so that the interviewer/auditor can affirmatively indicate whether the respondent is the beneficiary or the rep payee. Upon resubmission, SSA should include in the supporting statement information about the percentage of interviewees who were beneficiaries and the percentage who were rep payees.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved	08/31/2007
Responses	200	0	200
Time Burden (Hours)	50	0	50
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected through the Beneficiary Interview and Auditor's Observations form will be used by SSA's Office of the Inspector General (OIG) to interview beneficiaries and/or their care givers to determine whether representative payees are complying with their duties and responsibilities. Respondents to this collection will be randomly selected Supplemental Security Income recipients and Social Security beneficiaries that have representative payees.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 12244	03/15/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 26443	05/09/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Beneficiary Interview and Auditor's Observations	SSA-322	Beneficiary Interview and Auditor's Observations

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ICR Summary 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	200	200	0	0	0	0
Annual Time Burden (Hours)	50	50	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $3,080

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/21/2007

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