Information Collection

Beneficiary Interview and Auditor's Observations

IC 9653 under ICR 200702-0960-003 · OMB 0960-0630.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0630 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSA-322 Beneficiary Interview and Auditor's Observations	Form
SSA-322 Beneficiary Interview and Auditor's Observations Beneficiary Interview Observation Form 11-20-03.doc	Form

IC Title:

Beneficiary Interview and Auditor's Observations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 416.635 20 CFR 404.2035

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-322	Beneficiary Interview and Auditor's Observations	Beneficiary Interview Observation Form 11-20-03.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.