Information Collection

Beneficiary Interview and Auditor's Observations

IC 9653 under ICR 201008-0960-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Beneficiary Interview and Auditor's Observations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.