Information Collection

Beneficiary Interview and Auditor's Observations

IC 9653 under ICR 201002-0960-019 · 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⚠️ Notice: This information collection may be referencing outdated material.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 (revised).pdf	Form
Beneficiary Interview Observation Form.doc Beneficiary Interview and Auditor's Observations (original)	IC Document

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:

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 (revised).pdf		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
Beneficiary Interview and Auditor's Observations (original)	Beneficiary Interview Observation Form.doc	03/09/2010

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